Provider Demographics
NPI:1528187481
Name:JANICKI, ANNA J (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:J
Last Name:JANICKI
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 1:2460 FAIRMOUNT BLVD
Mailing Address - Street 2:# 301A
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3171
Mailing Address - Country:US
Mailing Address - Phone:216-229-7141
Mailing Address - Fax:216-229-7321
Practice Address - Street 1:2460 FAIRMOUNT BLVD
Practice Address - Street 2:# 301A
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3171
Practice Address - Country:US
Practice Address - Phone:216-229-7141
Practice Address - Fax:216-229-7321
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350452092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC02100Medicare UPIN