Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 353 | WV |
N | 222Z00000X | Podiatrist | 353 | WV |
Y | 213E00000X | Podiatrist | 36-00-2979 | OH |
Y | 222Z00000X | Podiatrist | 36-00-2979 | OH |
N | 213E00000X | Podiatrist | SC-00-4569 | PA |
N | 222Z00000X | Podiatrist | SC-00-4569 | PA |
NPI | 1043217813 |
---|---|
Provider Name | Mark S Smesko |
First Address | Sandusky, OH 44871-0378 |
Second Address | East Palestine, OH 44413-2019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 21/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2134336 | (05) | OH |
6420011-000 | (05) | WV |