Provider Demographics
NPI:1346345683
Name:JANOWICZ, JANINE L (MD)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:L
Last Name:JANOWICZ
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:PO BOX 80690
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-833-5530
Mailing Address - Fax:330-833-6085
Practice Address - Street 1:1605 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-478-5595
Practice Address - Fax:330-478-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0629823Medicaid
OH0753662Medicaid
OH0629823Medicaid
E78453Medicare UPIN
7147281Medicare ID - Type Unspecified