Healthcare Provider Details

I. General information

NPI: 1790836807
Provider Name (Legal Business Name): JANUSZ A MEJER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 N ARLINGTON HEIGHTS RD STE G-K
ARLINGTON HEIGHTS IL
60004-1573
US

IV. Provider business mailing address

15 OLD BARN RD
HAWTHORN WOODS IL
60047-9149
US

V. Phone/Fax

Practice location:
  • Phone: 224-347-2564
  • Fax:
Mailing address:
  • Phone: 773-822-2564
  • Fax: 312-588-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036117274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: