Provider Demographics
NPI:1285620617
Name:SMITH, MICHAEL C (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:348 MURDOCK
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-5939
Mailing Address - Fax:312-942-2238
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:1106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-4500
Practice Address - Fax:312-942-2380
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360736032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073603Medicaid
IL336037196OtherIL DEPT OF PROF REG
IL336037196OtherIL DEPT OF PROF REG
IL036073603Medicaid
IL336037196OtherIL DEPT OF PROF REG