Healthcare Provider Details

I. General information

NPI: 1114551983
Provider Name (Legal Business Name): KATHERINE JANEZIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 N MILWAUKEE AVE
NILES IL
60714-3707
US

IV. Provider business mailing address

7411 N MILWAUKEE AVE
NILES IL
60714-3707
US

V. Phone/Fax

Practice location:
  • Phone: 773-763-6000
  • Fax: 773-763-6006
Mailing address:
  • Phone: 773-763-6000
  • Fax: 773-763-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number209020893
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: