Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016004833 | IL |
Y | 222Z00000X | Podiatrist | 016004833 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 016004833 | IL |
NPI | 1033190079 |
---|---|
Provider Name | Dr. Carlos Frederick Smith |
First Address | Chicago, IL 60610-1174 |
Second Address | Chicago, IL 60653-4507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 21/06/2021 |