Healthcare Provider Details

I. General information

NPI: 1497146278
Provider Name (Legal Business Name): JOHN THOMAS SMETONA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2015
Last Update Date: 09/05/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 S 52ND AVE
OAK LAWN IL
60453-3054
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-9330
  • Fax: 847-723-9051
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036.161424
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: