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General NPI Number Information
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NPI Number | 1528453453
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Entity Type | Individual
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Provider Name | KARL WALTER JANICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 3750 LANDMARK DR STE B
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City | LAFAYETTE
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State | IN
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Zip | 47905-6652
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Country | US
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Telephone | 765-448-8000
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Fax | 765-448-7635
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 01087255A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 5577-851
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License Number State | WI
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