Healthcare Provider Details

I. General information

NPI: 1407070329
Provider Name (Legal Business Name): RAYMOND V JANEVICIUS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W BUTTERFIELD RD SUITE 230
ELMHURST IL
60126-5068
US

IV. Provider business mailing address

360 W BUTTERFIELD RD SUITE 230
ELMHURST IL
60126-5068
US

V. Phone/Fax

Practice location:
  • Phone: 630-833-1800
  • Fax:
Mailing address:
  • Phone: 630-833-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number036058908
License Number StateIL

VIII. Authorized Official

Name: RAYMOND V JANEVICIUS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-833-1800