Provider Demographics
NPI:1144911306
Name:SMITH, MEGHAN JOY (MD FRCSC)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:JOY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S ASHLAND AVE APT 908
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4090
Mailing Address - Country:US
Mailing Address - Phone:773-397-4334
Mailing Address - Fax:
Practice Address - Street 1:820 SOUTH WOOD STREET UI HEALTH, GRADUATE MEDICAL EDUC
Practice Address - Street 2:SUITE 100 MC 675
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-996-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2024-04-10
Deactivation Date:2023-12-21
Deactivation Code:
Reactivation Date:2024-01-10
Provider Licenses
StateLicense IDTaxonomies
IL125.081827390200000X
IL125081827207WX0108X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program