=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831176874
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GHASSAN M JANO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2005
-----------------------------------------------------
Last Update Date | 02/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 929 RIDGE RD SUITE 5
-----------------------------------------------------
City | MUNSTER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46321-1751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-836-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 E 89TH AVE SUITE 2A
-----------------------------------------------------
City | MERRILLVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46410-7319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-736-2800
-----------------------------------------------------
Fax | 219-736-6680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 01040756
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------