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
Fax: (773) 624-0367
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386784346 NPPES
Illinois Other 036-36570 STATE LICENSE

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