Marc Gerald Smith, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

3355 Illinois St
BLDG 1007
Great Lakes, IL 60088-3115

Phone

(847) 688-4346

Fax

(847) 688-3690

NPI assigned

Apr 11, 2011

Last updated

Apr 11, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302480000000",
    "number": "1497045579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 ILLINOIS ST",
            "address_2": "BLDG 1405",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600883115",
            "telephone_number": "847-688-4346",
            "fax_number": "847-688-3690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 ILLINOIS ST",
            "address_2": "BLDG 1007",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600883115",
            "telephone_number": "847-688-4346",
            "fax_number": "847-688-3690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARC",
        "middle_name": "GERALD",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-11",
        "last_updated": "2011-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kambez Shukoor, D.D.S.
• James Albert Shumaker Sr., IDC
• Faan Yeen Sidor, PSYD
• Bradford Lawrence Smith, M.D.
• Karen Shelburne Smith, D.M.D.
• Kortney Spectre
• Brett Staib, NAVY IDC
• Jeffrey A Staples, DDS
• Mark Edward Stone, DDS
• Sarah Elizabeth Strand-Kolasa, PSY.D

• Independent Duty Corpsman in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• Independent Duty Corpsman in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.