Healthcare Provider Details

I. General information

NPI: 1780882472
Provider Name (Legal Business Name): MICHAEL R SMALARA MT (ASCP)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH AVE AND ROOSEVELT RD EDWARD HINES JR HOSPITAL
HINES IL
60141-5000
US

IV. Provider business mailing address

9338 BAYBERRY LN
TINLEY PARK IL
60487
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax:
Mailing address:
  • Phone: 708-614-0725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: