Smith, Jeremy

Smith, Jeremy is an individual health care provider with primary practice located at 1920 Football Dr , Lake Forest IL 60045-4829. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Sports. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Sports is his primary health care specialty. Smith, Jeremy can be contacted via phone (847) 739-5405.

Contact Information

Primary practice address
1920 Football Dr Lake Forest IL 60045-4829
Phone: (847) 739-5405
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X 096.002695 Illinois
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Sports 2251S0007X 070.016666 Illinois

Profile Details

NPI number 1184830812
LBN Legal business name Smith, Jeremy
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 16th, 2007
Last updated Aug 18th, 2013 - about 11 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 1184830812 NPPES
Illinois Other 070.016666 ILLINOIS STATE LICENSE
Illinois Other 070.016666 ILLINOIS STATE LICENSE
Illinois Other 096.002695 ILLINOIS STATE LICENSE
Illinois Other 096.002695 ILLINOIS STATE LICENSE

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