Healthcare Provider Details

I. General information

NPI: 1659330736
Provider Name (Legal Business Name): CENTRAL OTOLOGIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 GOLF ROAD
DELAFIELD WI
53018
US

IV. Provider business mailing address

888 THACKERAY TRAIL STE 108
OCONOMOWOC WI
53066
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-7055
  • Fax:
Mailing address:
  • Phone: 262-567-0505
  • Fax: 262-567-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL CHARLES JANOWAK
Title or Position: PRESIDENT
Credential: MD
Phone: 262-567-0505