Healthcare Provider Details

I. General information

NPI: 1750739256
Provider Name (Legal Business Name): KEVIN JANEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 4660
ALBUQUERQUE NM
87106-4924
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-6530
  • Fax: 505-224-7479
Mailing address:
  • Phone: 505-563-6530
  • Fax: 505-224-7479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD2025-0696
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: