Provider Demographics
NPI:1205862711
Name:SMOGORZEWSKI, MIROSLAW (MD)
Entity Type:Individual
Prefix:DR
First Name:MIROSLAW
Middle Name:
Last Name:SMOGORZEWSKI
Suffix:
Gender:M
Credentials:MD
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 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5100
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48783207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0016910OtherGROUP MEDICAID PIN
CA00A487830OtherBLUE SHIELD
CA00A487830197OtherCAL OPTIMA
CAGR0100430OtherGROUP MEDICAL
CA00A487830Medicaid
CA1902846306OtherGROUP NPI
CAP00344790OtherRAILROAD MEDICARE
CAW18762OtherMEDICARE GROUP ID
CACE1617OtherGROUP RAILROAD MEDICARE
CAP00344790OtherRAILROAD MEDICARE
CA00A487830OtherBLUE SHIELD