Provider Demographics
NPI:1306069471
Name:SMITH, SARA BOBLICK (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:BOBLICK
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:SHELBY
Other - Last Name:BOBLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:DIVISION OF GENERAL PEDIATRICS (MC 856)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-7184
Mailing Address - Fax:312-413-0243
Practice Address - Street 1:840 S WOOD ST
Practice Address - Street 2:DIVISION OF GENERAL PEDIATRICS (MC 856)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-7184
Practice Address - Fax:312-413-0243
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083568207R00000X, 208000000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program