Provider Demographics
NPI:1326083783
Name:JANKI, PATRICIA H (MD, PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:H
Last Name:JANKI
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13601 WOODFOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-2908
Mailing Address - Country:US
Mailing Address - Phone:713-330-4325
Mailing Address - Fax:713-330-1910
Practice Address - Street 1:13601 WOODFOREST BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015
Practice Address - Country:US
Practice Address - Phone:713-330-4325
Practice Address - Fax:713-330-1910
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0042EWOtherBLUECROSS BLUESHIELD
TX76-0635534OtherTAX IDENTIFICATION NUMBER
TX029942201Medicaid
TX7992209OtherAETNA PROVIDER NUMBER
TX029942201Medicaid
TX0042EWOtherBLUECROSS BLUESHIELD