Provider Demographics
NPI:1427242452
Name:JOBANPUTRA, SMITA KETAN (MD)
Entity type:Individual
Prefix:DR
First Name:SMITA
Middle Name:KETAN
Last Name:JOBANPUTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SMITA
Other - Middle Name:VINODRAI
Other - Last Name:DHABALIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:396 REMINGTON BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4303
Mailing Address - Country:US
Mailing Address - Phone:630-759-2966
Mailing Address - Fax:630-759-9776
Practice Address - Street 1:396 REMINGTON BLVD STE 250
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4303
Practice Address - Country:US
Practice Address - Phone:630-759-2966
Practice Address - Fax:630-759-9776
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-117162207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
367830Medicare PIN