Healthcare Provider Details

I. General information

NPI: 1023245511
Provider Name (Legal Business Name): LUKE S JANIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE NORTHSHORE UNIVERSITY HEALTH SYSTEM; DEPT ANESTHESIA
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

2043 N BISSELL ST UNIT 2
CHICAGO IL
60614-4205
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL-239967
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD448427
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMT203419
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number036.138618
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: