Provider Demographics
NPI:1942393640
Name:SMEDEGARD, JAMES KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENNETH
Last Name:SMEDEGARD
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 1:12255 S 80TH AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-923-7878
Mailing Address - Fax:
Practice Address - Street 1:12255 S 80TH AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-923-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360715732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7229POtherCATERPILLAR
IL363827229 02OtherHERITAGE
IL219043OtherMAGELLAN
IL363827229OtherWPS
IL363827229 02OtherJOHN DEERE
ILL029112OtherCHAMPUS
IL260015287OtherRR MEDICARE
IL0991516762OtherBCBS
IL12368OtherJOHN HANCOCK
IL036071573Medicaid
IL055429OtherVALUE BEHAVIORAL HEALTH
ILL029112OtherCHAMPUS
IL055429OtherVALUE BEHAVIORAL HEALTH
ILL58631Medicare ID - Type UnspecifiedCOOK COUNTY