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Contact Information

MARK A SMITH, DPM
3322 W WILLOW KNOLLS DR
PEORIA, IL61614
 Phone: 309-691-5800
 Fax: 309-691-1336
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for MARK A SMITH · (Male)

NPI Number 1093885378
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 11/08/2006
Last updated 12/03/2009 - About 17 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 016004790
  • IL Medicaid 016004790
  • IL Other 0007215174 BLUE CROSS BLUE SHIELD
  • IL Other 928270 MEDICARE PROVIDER
  • IL Other 480022534 RAILROAD MEDICARE
Hospital affiliation(s)
  • SAINT FRANCIS MEDICAL CENTER - (Acute Care)
    530 NE GLEN OAK AVE
    PEORIA, IL 61637
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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