Provider Demographics
NPI:1073700688
Name:GERTA JANSS, MD, S.C.
Entity Type:Organization
Organization Name:GERTA JANSS, MD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-920-0225
Mailing Address - Street 1:711 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:711 11TH ST
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2662
Practice Address - Country:US
Practice Address - Phone:847-920-0225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036080132207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21604995OtherBLUE SHIELD OF ILLNOIS
IL21604995OtherBLUE SHIELD OF ILLNOIS