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NPI Code Detail

MEDICARE: PAUL JANOTKA MD

MEDICARE: PAUL JANOTKA 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
1207PE0004XEmergency Medical Services (Emergency Medicine) Physician29748OK
2207PE0004XEmergency Medical Services (Emergency Medicine) Physician70155GA
3207PE0004XEmergency Medical Services (Emergency Medicine) PhysicianME 107308FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
161400002OTHERMDBLUECROSS PROVIDER NUMBER
270155OTHERGAMEDICAL LICENSE
3ME 107308OTHERFLMEDICAL LICENSE

General Provider Information

NPI Number : 1639106289
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL JANOTKA MD
Provider Business Mailing Address
First Line : 5010 CAMBERLEY LN
Second Line :
City : OLDSMAR
State : FL
Zip : 34677-5113
Country : US
Telephone Number : 727-286-6531
Fax Number :
Provider Business Practice Location Address
First Line : 707 OLD DALTON ELLIJAY RD
Second Line :
City : CHATSWORTH
State : GA
Zip : 30705-2029
Country : US
Telephone Number : 706-517-2093
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 11/04/2015

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Directions to “ PAUL JANOTKA MD” Practice Location

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