Provider Demographics
NPI:1720042922
Name:SMITH, JAMIERE YOLANDE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIERE
Middle Name:YOLANDE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 S INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4310
Mailing Address - Country:US
Mailing Address - Phone:773-779-8285
Mailing Address - Fax:773-324-2355
Practice Address - Street 1:9951 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1035
Practice Address - Country:US
Practice Address - Phone:773-779-8285
Practice Address - Fax:773-779-8420
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087325207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087325Medicaid
ILMEDICAREOther214485
IL194921OtherAMERIGROUP PROVIDER#
IL1635082OtherBLUE CROSS INDIVIDUAL #
IL036087325Medicaid