Provider Demographics
NPI:1144338286
Name:SMEAL, WESLEY L (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:L
Last Name:SMEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 N. 72ND ST.
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122
Mailing Address - Country:US
Mailing Address - Phone:402-572-2295
Mailing Address - Fax:402-572-2632
Practice Address - Street 1:17021 LAKESIDE HILLS DR.
Practice Address - Street 2:STE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:847-631-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112826208100000X, 2081P2900X, 208VP0000X, 208VP0014X
NE245292081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112826Medicaid
NE47037661525Medicaid
ILK30446Medicare PIN
ILK32182Medicare PIN
IL036112826Medicaid
NE47037661525Medicaid
ILK30447Medicare PIN