Provider Demographics
NPI:1376616706
Name:MADEJ, JANUSZ J (MD)
Entity Type:Individual
Prefix:DR
First Name:JANUSZ
Middle Name:J
Last Name:MADEJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:MADEJ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:339 S SAN ANTONIO RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-3699
Mailing Address - Country:US
Mailing Address - Phone:650-529-1669
Mailing Address - Fax:650-529-1670
Practice Address - Street 1:339 S SAN ANTONIO RD STE 1A
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-3699
Practice Address - Country:US
Practice Address - Phone:650-529-1669
Practice Address - Fax:650-529-1670
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A695310Medicare ID - Type Unspecified
CAH13619Medicare UPIN