Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 16-2719 | IL |
NPI | 1205831948 |
---|---|
Provider Name | Dr. Bruce William Smit |
First Address | Frankfort, IL 60423-1930 |
Second Address | Frankfort, IL 60423-1930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2005 |
Last Update Date | 28/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60100822 | BC\BS (01) | IL |
T36194 | (02) | IL |