Provider Demographics
NPI:1689767642
Name:GOLNICK, JAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:J
Last Name:GOLNICK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:16945 FRANCES ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2312
Mailing Address - Country:US
Mailing Address - Phone:402-926-4200
Mailing Address - Fax:402-926-4210
Practice Address - Street 1:16945 FRANCES ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2312
Practice Address - Country:US
Practice Address - Phone:402-926-4200
Practice Address - Fax:402-926-4210
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-02-05
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Provider Licenses
StateLicense IDTaxonomies
NE146612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1689767642OtherMEDICARE NPI
NE47070432000Medicaid
NE47070432000Medicaid