Provider Demographics
NPI:1619170263
Name:SMITH, GRETCHEN (MD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:JEANNE
Other - Last Name:ZWEIFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 RENAISSANCE DR STE 307
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1343
Mailing Address - Country:US
Mailing Address - Phone:847-803-1000
Mailing Address - Fax:847-803-1098
Practice Address - Street 1:250 E SUPERIOR ST STE 4-2305
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-926-5522
Practice Address - Fax:312-695-5645
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080141182085R0202X
IL0361484362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology