Provider Demographics
NPI:1043217813
Name:SMESKO, MARK S (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:SMESKO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:136 N MARKET ST
Practice Address - Street 2:
Practice Address - City:EAST PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413-2019
Practice Address - Country:US
Practice Address - Phone:330-426-1828
Practice Address - Fax:330-426-1839
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV353213E00000X
PASC-00-4569213E00000X
OH36-00-2979213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2134336Medicaid
WV6420011-000Medicaid
OH2134336Medicaid
WV6420011-000Medicaid
0880619Medicare ID - Type Unspecified
4013453Medicare ID - Type Unspecified
4010743Medicare ID - Type Unspecified
0880618Medicare ID - Type Unspecified
4010745Medicare ID - Type Unspecified
0880612Medicare ID - Type Unspecified
4010741Medicare ID - Type Unspecified
4010746Medicare ID - Type Unspecified
0880613Medicare ID - Type Unspecified
0880616Medicare ID - Type Unspecified
0880617Medicare ID - Type Unspecified
WV4013452Medicare PIN
OH0880611Medicare ID - Type Unspecified
4013456Medicare ID - Type Unspecified
40107455Medicare ID - Type Unspecified