Provider Demographics
NPI:1013027887
Name:JACK JANIGIAN DPM PC
Entity Type:Organization
Organization Name:JACK JANIGIAN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:JANIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-682-2900
Mailing Address - Street 1:43134 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2718
Mailing Address - Country:US
Mailing Address - Phone:248-682-2900
Mailing Address - Fax:810-688-1759
Practice Address - Street 1:42925 7 MILE
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2277
Practice Address - Country:US
Practice Address - Phone:248-349-3900
Practice Address - Fax:248-348-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI000709213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1948616Medicaid
MIF36423002Medicare ID - Type Unspecified
MI1948616Medicaid
MI4628470001Medicare NSC