=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447266432
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET TODORCZUK MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 02/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11525 OLDE CABIN RD
-----------------------------------------------------
City | CREVE COEUR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-7146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-997-0554
-----------------------------------------------------
Fax | 314-997-5086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11525 OLDE CABIN RD
-----------------------------------------------------
City | CREVE COEUR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-7146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-997-0554
-----------------------------------------------------
Fax | 314-997-5086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | R2K13
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------