Healthcare Provider Details

I. General information

NPI: 1972436657
Provider Name (Legal Business Name): ALEC JANOTKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W HIGHLAND RD
NORTHFIELD OH
44067-2605
US

IV. Provider business mailing address

215 W HIGHLAND RD
NORTHFIELD OH
44067-2605
US

V. Phone/Fax

Practice location:
  • Phone: 216-217-7248
  • Fax:
Mailing address:
  • Phone: 216-217-7248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.0021553
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: