Healthcare Provider Details

I. General information

NPI: 1427260959
Provider Name (Legal Business Name): JOSEPH ALOYSIUS JANICKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE BOX #69
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE BOX #69
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6190
  • Fax: 312-227-9404
Mailing address:
  • Phone: 312-227-6190
  • Fax: 312-227-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number036.118217
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: