Provider Demographics
NPI:1790834943
Name:JANKOWSKI, MARTIN P (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:P
Last Name:JANKOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MARCIN
Other - Middle Name:P
Other - Last Name:JANKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:704 EMMET ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2910
Mailing Address - Country:US
Mailing Address - Phone:231-347-5511
Mailing Address - Fax:231-348-2515
Practice Address - Street 1:302 ORCHARD RIDGE DR
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8414
Practice Address - Country:US
Practice Address - Phone:231-347-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH77777Medicare UPIN
MIN27520044Medicare ID - Type Unspecified