Provider Demographics
NPI:1265721575
Name:SMITH, DAVID REITER (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:REITER
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5000 S 5TH AVE
Mailing Address - Street 2:GMC CLINIC, 10E
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-3030
Mailing Address - Country:US
Mailing Address - Phone:708-202-2707
Mailing Address - Fax:708-202-7040
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:GMC CLINIC, 10E
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-202-2707
Practice Address - Fax:708-202-7040
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036135139207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program