MEDICARE: IVA A SMOLENS 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	35752	AZ
2	208600000X	Surgery Physician	35752	AZ

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	:	1992794564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVA A SMOLENS MD

Provider Business Mailing Address
First Line	:	2204 S DOBSON RD
Second Line	:	SUITE 204
City	:	MESA
State	:	AZ
Zip	:	85202-6457
Country	:	US
Telephone Number	:	480-782-6900
Fax Number	:	480-782-6905

Provider Business Practice Location Address
First Line	:	2204 S DOBSON RD
Second Line	:	SUITE 204
City	:	MESA
State	:	AZ
Zip	:	85202-6457
Country	:	US
Telephone Number	:	480-782-6900
Fax Number	:	480-782-6905

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	11/26/2014

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Directions to “ IVA A SMOLENS MD” Practice Location

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