Provider Demographics
NPI:1033412747
Name:EDWARD G. JANKOWSKI M.D. P.C.
Entity Type:Organization
Organization Name:EDWARD G. JANKOWSKI M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:JANKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-884-4080
Mailing Address - Street 1:20867 MACK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1356
Mailing Address - Country:US
Mailing Address - Phone:313-884-4080
Mailing Address - Fax:313-884-3769
Practice Address - Street 1:20867 MACK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1356
Practice Address - Country:US
Practice Address - Phone:313-884-4080
Practice Address - Fax:313-884-3769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048196207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0824454Medicare PIN