Provider Demographics
NPI:1760564215
Name:JANOWSKI, LAWRENCE S (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:S
Last Name:JANOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 W 120TH AVENUE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020
Mailing Address - Country:US
Mailing Address - Phone:303-625-2225
Mailing Address - Fax:303-635-1078
Practice Address - Street 1:6363 W 120TH AVENUE
Practice Address - Street 2:SUITE 302
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020
Practice Address - Country:US
Practice Address - Phone:303-625-2225
Practice Address - Fax:303-635-1078
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41654021Medicaid
COC536988Medicare ID - Type Unspecified
CO41654021Medicaid