Smith, Charli Walter Leroy

Smith, Charli Walter Leroy is an individual health care provider with primary practice located at 608 Rollie Moore Dr , Harrisburg IL 62946-2351. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Smith, Charli Walter Leroy can be contacted via phone (618) 252-6150.

Contact Information

Primary practice address
608 Rollie Moore Dr Harrisburg IL 62946-2351
Phone: (618) 252-6150
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine 2083P0011X 036139019 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036139019 Illinois

Profile Details

NPI number 1649611252
LBN Legal business name Smith, Charli Walter Leroy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2013
Last updated May 13th, 2022 - about 3 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 1649611252 NPPES
Illinois Other 214881 MEDICARE GROUP

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