Healthcare Provider Details

I. General information

NPI: 1518903434
Provider Name (Legal Business Name): SCOTT JOSEPH JANUZIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E WASHINGTON ST
BLOOMINGTON IL
61701-4364
US

IV. Provider business mailing address

2538 MOMENTUM PL
CHICAGO IL
60689-0001
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-3311
  • Fax:
Mailing address:
  • Phone: 616-975-1845
  • Fax: 616-975-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036070816
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: