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General NPI Number Information
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NPI Number | 1700697257
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Entity Type | Individual
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Provider Name | NATHAN RONALD JANOWICZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 9001 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7041
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Country | US
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Telephone | 219-795-3360
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 S 575 W
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City | HEBRON
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State | IN
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Zip | 46341-9532
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Country | US
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Telephone | 219-308-2075
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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