Provider Demographics
NPI:1780882472
Name:SMALARA, MICHAEL R (MT (ASCP))
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:SMALARA
Suffix:
Gender:M
Credentials:MT (ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9338 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487
Mailing Address - Country:US
Mailing Address - Phone:708-614-0725
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE AND ROOSEVELT RD
Practice Address - Street 2:EDWARD HINES JR HOSPITAL
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5000
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist