Provider Demographics
NPI:1083029870
Name:JANOWAK, ELISE SUZAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:SUZAN
Last Name:JANOWAK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 NW HAWTHORNE AVE SUITE 110
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-471-7056
Mailing Address - Fax:541-474-3201
Practice Address - Street 1:2019 GALISTEO ST STE K-2
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2143
Practice Address - Country:US
Practice Address - Phone:505-395-9575
Practice Address - Fax:877-540-1253
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP184546213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery