Provider Demographics
NPI:1730187600
Name:SMILANICH, ROBERT P (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:SMILANICH
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 1:1055 N 300 W
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3374
Mailing Address - Country:US
Mailing Address - Phone:801-374-9100
Mailing Address - Fax:801-374-9117
Practice Address - Street 1:1055 N 300 W
Practice Address - Street 2:SUITE 205
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3374
Practice Address - Country:US
Practice Address - Phone:801-374-9100
Practice Address - Fax:801-374-9117
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3089384-12052086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT638375OtherDMBA
UT870656925SM1OtherEMIA
UT30893841201001OtherBLUE CROSS
UT638375OtherDMBA
UT870656925SM1OtherEMIA