Provider Demographics
NPI:1487621751
Name:SMUS, SERGEI (LMT)
Entity type:Individual
Prefix:MR
First Name:SERGEI
Middle Name:
Last Name:SMUS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 BARCLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4530
Mailing Address - Country:US
Mailing Address - Phone:847-465-8415
Mailing Address - Fax:847-465-8608
Practice Address - Street 1:1546 BARCLAY BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4530
Practice Address - Country:US
Practice Address - Phone:847-465-8415
Practice Address - Fax:847-465-8608
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635656OtherBLUE CROSS BLUE SHIELD