Coran Smith

Primary specialty

DriverTaxonomy code 172A00000X

License

S53010478239 Issued in IL

Practice address

517 W 103Rd PL
Chicago, IL 60628-2407

Phone

(773) 812-5675

NPI assigned

Jan 16, 2022

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

State licenses

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

{
    "created_epoch": "1642291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642291200000",
    "number": "1790436277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 S MAIN ST STE 700",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599015635",
            "telephone_number": "773-812-5675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 W 103RD PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606282407",
            "telephone_number": "773-812-5675"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6545 W Dickens Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "607073482",
            "country_code": "US",
            "telephone_number": "773-812-5675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CORAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-16",
        "last_updated": "2022-01-16",
        "certification_date": "2022-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "IL",
            "license": "S53010478239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clarissa Beth Smith, MD
• Clasina Leslie Smith, M.D.
• Clifford A. Smith, PHD
• Collette Smith, COTA/L
• Conner Smith, RN
• Corinne Reidy Smith, RDN
• Courtney Anne Smith, OT
• Crystal Smith, FNP-C
• Curren Dale Smith
• Dale M Smith, D.P.M.

• Driver in Chicago, IL
• Providers in Chicago, IL by specialty
• Driver in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2022; 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.