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NPI Code Detail

MEDICARE: ANDREW JANICKI MD

MEDICARE: ANDREW JANICKI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianU9980TX
2207Q00000XFamily Medicine PhysicianR76661AZ

General Provider Information

NPI Number : 1083105936
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW JANICKI MD
Provider Business Mailing Address
First Line : 301 UNIVERSITY BLVD
Second Line :
City : GALVESTON
State : TX
Zip : 77555-1120
Country : US
Telephone Number : 409-772-2166
Fax Number : 409-772-2663
Provider Business Practice Location Address
First Line : 6710 STEWART RD STE 100
Second Line :
City : GALVESTON
State : TX
Zip : 77551-2216
Country : US
Telephone Number : 409-744-4030
Fax Number : 409-740-4187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2018
Last Update Date : 03/12/2026

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