Provider Demographics
NPI:1396757407
Name:VARNADO-SMITH, SUNNETTE CHRISTINE (MD, FAAP)
Entity type:Individual
Prefix:MRS
First Name:SUNNETTE
Middle Name:CHRISTINE
Last Name:VARNADO-SMITH
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:SUNNETTE
Other - Middle Name:C
Other - Last Name:VARNADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:305 RUTH STREET
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5227
Mailing Address - Country:US
Mailing Address - Phone:708-305-3403
Mailing Address - Fax:708-862-0211
Practice Address - Street 1:305 RUTH STREET
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5227
Practice Address - Country:US
Practice Address - Phone:708-305-3403
Practice Address - Fax:708-862-0211
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-082280208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE91482Medicare UPIN