Provider Demographics
NPI:1659330736
Name:CENTRAL OTOLOGIC LTD
Entity Type:Organization
Organization Name:CENTRAL OTOLOGIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:JANOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-567-0505
Mailing Address - Street 1:888 THACKERAY TRAIL
Mailing Address - Street 2:STE 108
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:262-567-0505
Mailing Address - Fax:262-567-0778
Practice Address - Street 1:2750 GOLF ROAD
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018
Practice Address - Country:US
Practice Address - Phone:262-928-7055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32684000Medicaid
WI567627OtherDEAN HEALTH
WI32684000Medicaid
WI567627OtherDEAN HEALTH
WI567627OtherDEAN HEALTH