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General NPI Number Information
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NPI Number | 1467487975
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Entity Type | Individual
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Provider Name | ROMAN M SMYK MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 460 N BROADWAY ST
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City | COAL CITY
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State | IL
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Zip | 60416-1045
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Country | US
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Telephone | 815-634-2592
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Fax | 815-634-4052
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Provider Business Mailing Address
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Address Line | 35 E WILLOW ST STE B
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City | COAL CITY
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State | IL
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Zip | 60416-1869
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Country | US
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Telephone | 815-634-3048
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Fax | 815-634-8188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036066804
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License Number State | IL
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