Provider Demographics
NPI:1992794564
Name:SMOLENS, IVA A (MD)
Entity type:Individual
Prefix:
First Name:IVA
Middle Name:A
Last Name:SMOLENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2204 S DOBSON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6457
Mailing Address - Country:US
Mailing Address - Phone:480-782-6900
Mailing Address - Fax:480-782-6905
Practice Address - Street 1:2204 S DOBSON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6457
Practice Address - Country:US
Practice Address - Phone:480-782-6900
Practice Address - Fax:480-782-6905
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2014-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ35752208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ139163Medicaid
F67322Medicare UPIN