Provider Demographics
NPI:1578668505
Name:SMIALEK, RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SMIALEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 ALTAIR PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7647
Mailing Address - Country:US
Mailing Address - Phone:614-898-7546
Mailing Address - Fax:614-794-4294
Practice Address - Street 1:430 ALTAIR PKWY
Practice Address - Street 2:STE 210
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7647
Practice Address - Country:US
Practice Address - Phone:614-898-7546
Practice Address - Fax:614-794-4294
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002111208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00080760OtherRAILROAD MEDICARE
OH0906461Medicaid
OHC02979Medicare UPIN
OH0906461Medicaid