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General NPI Number Information
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NPI Number | 1780882472
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Entity Type | Individual
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Provider Name | MICHAEL R SMALARA MT (ASCP)
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Gender | Male
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5TH AVE AND ROOSEVELT RD EDWARD HINES JR HOSPITAL
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City | HINES
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State | IL
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Zip | 60141-5000
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Country | US
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Telephone | 708-202-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 9338 BAYBERRY LN
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City | TINLEY PARK
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State | IL
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Zip | 60487
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Country | US
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Telephone | 708-614-0725
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Fax |
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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 | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number |
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License Number State | IL
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