Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125058719 | IL |
N | 111NI0900X | Internist | 125058719 | IL |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036132864 | IL |
NPI | 1982914990 |
---|---|
Provider Name | Bryan Anthony Smith |
First Address | Burr Ridge, IL 60527-5965 |
Second Address | Chicago, IL 60637-1641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2010 |
Last Update Date | 31/01/2018 |