Provider Demographics
NPI:1386159994
Name:SMERKO, DENNIS (CPO, LPO)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:SMERKO
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5027 GREEN BAY RD STE 124
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1771
Mailing Address - Country:US
Mailing Address - Phone:262-654-4300
Mailing Address - Fax:262-654-4305
Practice Address - Street 1:5027 GREEN BAY RD STE 124
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1771
Practice Address - Country:US
Practice Address - Phone:262-654-4300
Practice Address - Fax:262-654-4305
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213.000137222Z00000X
IL211.000089224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist