MEDICARE: DR. HERBERT MICHAEL JANKLOW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	G11196	CA

General Provider Information

NPI Number	:	1194756072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERBERT MICHAEL JANKLOW MD

Provider Business Mailing Address
First Line	:	PO BOX 732
Second Line	:
City	:	SANTA YNEZ
State	:	CA
Zip	:	93460-0732
Country	:	US
Telephone Number	:	805-688-6171
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 SAGUNTO ST
Second Line	:
City	:	SANTA YNEZ
State	:	CA
Zip	:	93460-9577
Country	:	US
Telephone Number	:	805-688-6171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	12/13/2011

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