Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 036101688 | IL |
NPI | 1215997408 |
---|---|
Provider Name | Brian A Smart |
First Address | Chicago, IL 60674-0018 |
Second Address | Glen Ellyn, IL 60137-4464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 27/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036101688 | (05) | IL |