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Individual

ROMAN P SMULKA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
15245 BLUEBIRD ST NW, MAIL STOP 39200A RIVERWAY CLINIC - ANDOVER, ANDOVER, MN 55304-3554
(763) 587-4600
(763) 587-4615
Mailing address
15245 BLUEBIRD ST NW, ANOKA, MN 55304-3538
(763) 587-4600
(763) 587-4615

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27033
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
668585400
MN
Enumeration date
02/14/2006
Last updated
01/21/2013
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