Provider Demographics
NPI:1669469276
Name:SMOOKLER, ALAN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MARTIN
Last Name:SMOOKLER
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 1:2180 PFINGSTEN RD.
Mailing Address - Street 2:KELLOGG CANCER CENTER
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1339
Mailing Address - Country:US
Mailing Address - Phone:847-503-4222
Mailing Address - Fax:247-503-4220
Practice Address - Street 1:2180 PFINGSTEN RD.
Practice Address - Street 2:KELLOGG CANCER CENTER
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-503-4222
Practice Address - Fax:247-503-4220
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070513207RG0300X, 207R00000X
IL036-070513207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110213054OtherRAILROAD MEDICARE
IL036070513OtherPUBLIC AID
110050091OtherRR MCA
AS3157989OtherDEA
110050091OtherRR MCA
IL110213054OtherRAILROAD MEDICARE
ILK16224Medicare ID - Type Unspecified
110050091OtherRR MCA
IL110213054OtherRAILROAD MEDICARE