=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205484730
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WALTER JANKE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2019
-----------------------------------------------------
Last Update Date | 08/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1193 SOUTH FEDERAL HIGHWAY
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-353-1225
-----------------------------------------------------
Fax | 561-353-9958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9960 CENTRAL PARK BLVD N STE 450
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-1760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-353-1225
-----------------------------------------------------
Fax | 561-353-9958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 22801
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------