MEDICARE: DR. SHIRLENE K SMOOK MD

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	207Q00000X	Family Medicine Physician	4778	SD

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	:	1578528576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRLENE K SMOOK MD

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 W 17TH ST STE G01
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-4664
Country	:	US
Telephone Number	:	605-312-3400
Fax Number	:

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	02/03/2022

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Directions to “ DR. SHIRLENE K SMOOK MD” Practice Location

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