Provider Demographics
NPI:1629165907
Name:SMILO, JOHN M (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:SMILO
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 1:1410 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2239
Mailing Address - Country:US
Mailing Address - Phone:740-295-3325
Mailing Address - Fax:740-295-3327
Practice Address - Street 1:249 KENWOOD DR
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1997
Practice Address - Country:US
Practice Address - Phone:740-295-3325
Practice Address - Fax:740-295-3327
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002663213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2051738Medicaid
OH0849071Medicare ID - Type Unspecified
OHU21292Medicare UPIN
PA212137Medicare UPIN