Provider Demographics
NPI:1568462760
Name:AKUS, JAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:J
Last Name:AKUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAN
Other - Middle Name:J
Other - Last Name:AKUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2915
Mailing Address - Country:US
Mailing Address - Phone:860-886-1494
Mailing Address - Fax:860-886-8500
Practice Address - Street 1:5 CLINIC DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2915
Practice Address - Country:US
Practice Address - Phone:860-886-1494
Practice Address - Fax:860-886-8500
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017450207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001174507Medicaid
CT110000777OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)
CT110000777OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)