Provider Demographics
NPI:1821060039
Name:SMITH, PAMELA E (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD MPH CHES SC
Mailing Address - Street 1:2701 W 68TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-1813
Mailing Address - Country:US
Mailing Address - Phone:773-490-8842
Mailing Address - Fax:773-277-0027
Practice Address - Street 1:1950 S AVERS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2450
Practice Address - Country:US
Practice Address - Phone:773-490-8842
Practice Address - Fax:773-277-0027
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062316207V00000X, 174400000X, 208D00000X, 208M00000X
IL10883174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062316Medicaid
ILC42702Medicare UPIN
IL036062316Medicaid