MEDICARE: LESLIE P SMOLUCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD10512	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891730768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE P SMOLUCH M.D.

Provider Business Mailing Address
First Line	:	1110 N 18TH ST
Second Line	:	SUITE 3
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-4200
Country	:	US
Telephone Number	:	541-726-6447
Fax Number	:	541-726-7704

Provider Business Practice Location Address
First Line	:	1110 N 18TH ST
Second Line	:	SUITE 3
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-4200
Country	:	US
Telephone Number	:	541-726-6447
Fax Number	:	541-726-7704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	07/08/2007

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