Provider Demographics
NPI:1255329546
Name:PIERSON, JANICE MAREA (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:MAREA
Last Name:PIERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 S RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2390
Mailing Address - Country:US
Mailing Address - Phone:708-293-7004
Mailing Address - Fax:773-694-5230
Practice Address - Street 1:12800 S RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2390
Practice Address - Country:US
Practice Address - Phone:708-293-7004
Practice Address - Fax:773-694-5230
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046761A207R00000X
IL036088112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK07335Medicare ID - Type Unspecified
ILF72497Medicare UPIN