Provider Demographics
NPI:1003808932
Name:JANIK, JOSEPH S (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:JANIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4706
Mailing Address - Country:US
Mailing Address - Phone:602-865-4065
Mailing Address - Fax:602-865-6100
Practice Address - Street 1:5310 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4706
Practice Address - Country:US
Practice Address - Phone:602-865-4065
Practice Address - Fax:602-865-6100
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ320782086S0120X
CO237532086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0738820OtherBCBS
AZ539801Medicaid
AZAZ0738820OtherBCBS