Provider Demographics
NPI:1306957162
Name:SMIK, STEPHEN PAUL (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PAUL
Last Name:SMIK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3386 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2031
Mailing Address - Country:US
Mailing Address - Phone:216-941-0233
Mailing Address - Fax:216-941-0235
Practice Address - Street 1:3386 WARREN RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-2031
Practice Address - Country:US
Practice Address - Phone:216-941-0233
Practice Address - Fax:216-941-0235
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2511-S213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0740336Medicaid
OH480014834OtherRAILROAD MEDICARE
OHSM0631613Medicare ID - Type Unspecified
OH0740336Medicaid
OH480014834OtherRAILROAD MEDICARE