Provider Demographics
NPI:1639355803
Name:SMIELEWSKI PODIATRY INC.
Entity Type:Organization
Organization Name:SMIELEWSKI PODIATRY INC.
Other - Org Name:BUFFALO GROVE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIELEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-577-1649
Mailing Address - Street 1:1257 W DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4009
Mailing Address - Country:US
Mailing Address - Phone:847-577-1649
Mailing Address - Fax:847-577-1677
Practice Address - Street 1:1257 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4009
Practice Address - Country:US
Practice Address - Phone:847-577-1649
Practice Address - Fax:847-577-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003705261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60015169OtherBC/BS IL PROVIDER NUMBER
IL=========OtherFOOT FIRST PODIATRY FEIN
ILT38294Medicare UPIN
IL=========OtherFOOT FIRST PODIATRY FEIN
IL2593410001Medicare NSC