Smith, Carroll Edward
Smith, Carroll Edward is an sole proprietor health care provider with primary practice located at 4215 S King Dr , Chicago IL 60653-2663. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adult Medicine, which is considered as his primary health care specialty. Smith, Carroll Edward can be contacted via phone (773) 624-0366.Contact Information
Primary practice address
4215 S King Dr
Chicago IL 60653-2663
Phone: (773) 624-0366
Fax: (773) 624-0367
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Adult Medicine | 207QA0505X | 036-36570 | Illinois |
Profile Details
| NPI number | 1386784346 |
|---|---|
| LBN Legal business name | Smith, Carroll Edward |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 7th, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386784346 | NPPES |
| Illinois | Other | 036-36570 | STATE LICENSE |
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