Provider Demographics
NPI:1942459292
Name:SMITH, ELEANOR GWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:GWEN
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 1:530 WINNETKA AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-4023
Mailing Address - Country:US
Mailing Address - Phone:847-441-6869
Mailing Address - Fax:847-441-6895
Practice Address - Street 1:530 WINNETKA AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-4023
Practice Address - Country:US
Practice Address - Phone:847-441-6869
Practice Address - Fax:847-441-6895
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-054413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine