Provider Demographics
NPI:1649438565
Name:SMITH, SIKA S (CRNA)
Entity type:Individual
Prefix:
First Name:SIKA
Middle Name:S
Last Name:SMITH
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S STATE ST STE 433
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-5522
Mailing Address - Country:US
Mailing Address - Phone:312-900-2894
Mailing Address - Fax:
Practice Address - Street 1:100 S STATE ST STE 433
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-5522
Practice Address - Country:US
Practice Address - Phone:312-900-2894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012363367500000X
IL041.356526163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine