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General NPI Number Information
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NPI Number | 1851369771
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Entity Type | Organization
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Legal Business Name | CENTRAL OTOLOGIC LTD
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 N MAYFAIR ROAD STE 545
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City | MILWAUKEE
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State | WI
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Zip | 53266
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Country | US
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Telephone | 414-475-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 888 THACKERAY TRAIL STE 108
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City | OCONOMOWOC
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State | WI
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Zip | 53066
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Country | US
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Telephone | 262-567-0505
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Fax | 262-567-0778
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL CHARLES JANOWAK
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Credential | MD
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Telephone | 262-567-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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