Provider Demographics
NPI:1952729527
Name:SMITH, THOMAS WADDELL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WADDELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5140 N CALIFORNIA AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3645
Mailing Address - Country:US
Mailing Address - Phone:773-293-8878
Mailing Address - Fax:773-293-8879
Practice Address - Street 1:5140 N CALIFORNIA AVE STE 420
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-293-8878
Practice Address - Fax:773-293-8879
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361441532086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology