Basic Information
| Provider Information | |||||||||
| NPI: | 1891952990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | BECKY | ||||||||
| MiddleName: | ALISON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 W SCHOOL ST | ||||||||
| Address2: | APT 605 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606572140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192578853 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2650 RIDGE AVE | ||||||||
| Address2: | SUITE B124 | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602011718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701502 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2008 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 036127252 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | 127842 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.