Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 213.000137 | IL |
N | 222Z00000X | Podiatrist | 213.000137 | IL |
Y | 224P00000X | Prosthetist | 211.000089 | IL |
NPI | 1386159994 |
---|---|
Provider Name | Dennis Smerko |
First Address | Kenosha, WI 53144-1771 |
Second Address | Kenosha, WI 53144-1771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2017 |
Last Update Date | 05/12/2017 |