MICHAEL DAVID SMITH M.D., NPI 1386637148 — CHICAGO (IL)

NPI 1386637148

14+ Years Experience Individual

MICHAEL DAVID SMITH M.D.

08/26/2005
PROVIDER ENUMERATION DATE
12/15/2017
LAST UPDATE DATE
1386637148
NPI NUMBER

About MICHAEL DAVID SMITH

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

MICHAEL DAVID SMITH is a provider established in CHICAGO, IL. The NPI number of MICHAEL DAVID SMITH is 1386637148 and was assigned on 08/26/2005. The practitioners primary taxonomy code is: 2085R0202X with license number: 36078435 IL .

Mailing address

  • City: CHICAGO
  • State: IL
  • Postal code: 60611
  • Phone: 3123715200
  • Address: 600 N LAKE SHORE DR
  • Address 2: APT 3301

Primary Practice Address

  • Region : CHICAGO, IL
  • NPI : 1386637148
  • Phone : 3123715200
  • Fax : 3123715200
  • Postalcode : 60611
  • Address : 600 N LAKE SHORE DR APT 3301

Provider taxonomy - Radiology

  • Taxonomy code: 2085R0202X
  • License number: 36078435
  • License state: IL

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Contacts:

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  • MICHAEL DAVID SMITH M.D.
  • Address : 600 N LAKE SHORE DR APT 3301
  • Region : CHICAGO, IL
  • NPI : 1386637148
  • Phone : 3123715200
  • Fax : 3123715200
  • Postalcode : 60611

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address600 N LAKE SHORE DR
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressAPT 3301
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHICAGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code60611
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3123715200
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3123715200
The fax number associated with the location address of the provider being identified.
NPI1386637148
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 12085R0202X
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Provider Enumeration Date08/26/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated12/15/2017
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)MICHAEL DAVID SMITH
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address600 N LAKE SHORE DR
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressAPT 3301
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameCHICAGO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code60611
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3123715200
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Healthcare Provider Taxonomy Code #12085R0202X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Provider License Number 136078435
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1IL
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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