Provider Demographics
NPI:1922028976
Name:SMEJKAL, PETR (MD)
Entity type:Individual
Prefix:MR
First Name:PETR
Middle Name:
Last Name:SMEJKAL
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 1:50 UNION ST
Mailing Address - Street 2:MAINE COAST MEMORIAL HOSPITAL
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-664-5304
Mailing Address - Fax:207-664-5305
Practice Address - Street 1:50 UNION ST
Practice Address - Street 2:MAINE COAST MEMORIAL HOSPITAL
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1534
Practice Address - Country:US
Practice Address - Phone:207-664-5304
Practice Address - Fax:207-664-5305
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017015208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME172601OtherMEDICARE PTAN
I47153Medicare UPIN
MEME1726Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MEME172603Medicare PIN