=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689654204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANICE ZUNICH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2006
-----------------------------------------------------
Last Update Date | 07/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | COMMUNITY DIAGNOSTIC CENTER 10020 DONALD POWERS DR.
-----------------------------------------------------
City | MUNSTER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-934-8856
-----------------------------------------------------
Fax | 219-934-8870
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | COMMUNITY DIAGNOSTIC CENTER 10020 DONALD POWERS DR.
-----------------------------------------------------
City | MUNSTER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-934-8856
-----------------------------------------------------
Fax | 219-934-8870
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207SC0300X
-----------------------------------------------------
Taxonomy Name | Clinical Cytogenetics Physician
-----------------------------------------------------
License Number | 01034266A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207SG0201X
-----------------------------------------------------
Taxonomy Name | Clinical Genetics (M.D.) Physician
-----------------------------------------------------
License Number | 01034266A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------