Provider Demographics
NPI:1710953815
Name:JANSS, GERTA S (MD)
Entity Type:Individual
Prefix:DR
First Name:GERTA
Middle Name:S
Last Name:JANSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GERTA
Other - Middle Name:S
Other - Last Name:JANSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:711 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091
Mailing Address - Country:US
Mailing Address - Phone:847-920-0225
Mailing Address - Fax:847-920-1725
Practice Address - Street 1:711 11TH ST
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091
Practice Address - Country:US
Practice Address - Phone:847-920-0225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036080132207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21604995OtherBLUE CROSS OF ILLINOIS
IL21604995OtherBLUE CROSS OF ILLINOIS