Provider Demographics
NPI:1083690507
Name:GICK, JANET F (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:F
Last Name:GICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 DUPONT CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2793
Mailing Address - Country:US
Mailing Address - Phone:513-576-7700
Mailing Address - Fax:513-576-1020
Practice Address - Street 1:140 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2239
Practice Address - Country:US
Practice Address - Phone:937-481-2930
Practice Address - Fax:937-382-4717
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.039082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0306127Medicaid
OH0306127Medicaid
OH0820444Medicare PIN
OHGI7366421Medicare PIN
OHP00376214Medicare PIN