Provider Demographics
NPI:1801878509
Name:SMENTEK, MARY KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:SMENTEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:DONOHOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:1230 E MAIN ST MANKATO CLINIC LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1230 E MAIN ST
Practice Address - Street 2:MANKATO CLINIC
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56002-8674
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49051208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001432575Medicaid
MN135991OtherUCARE
MN295C2SMOtherBCBS
IA0763177Medicaid
MN277140100Medicaid
MNNA2951049098OtherPREFERRED ONE
MN12 03867OtherMEDICA
MN284OtherAMERICAS PPO
MNHP75350OtherHEALTH PARTNERS
CT001432575Medicaid
370003264Medicare PIN