Basic Information
| Provider Information | |||||||||
| NPI: | 1144338286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMEAL | ||||||||
| FirstName: | WESLEY | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6901 N. 72ND ST. | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722295 | ||||||||
| FaxNumber: | 4025722632 | ||||||||
| Practice Location | |||||||||
| Address1: | 17021 LAKESIDE HILLS DR. | ||||||||
| Address2: | STE 200 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476315664 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 01/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 036-112826 | IL | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P2900X | 036-112826 | IL | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 208VP0000X | 036-112826 | IL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 036-112826 | IL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 2081P2900X | 24529 | NE | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 208100000X | 24529 | NE | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 036112826 | 05 | IL | MEDICAID | 47037661525 | 05 | NE | MEDICAID |