Provider Demographics
NPI:1851374904
Name:WOLANIUK, JANUSZ (MD)
Entity Type:Individual
Prefix:
First Name:JANUSZ
Middle Name:
Last Name:WOLANIUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 795083
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0795
Mailing Address - Country:US
Mailing Address - Phone:800-899-5757
Mailing Address - Fax:314-821-1833
Practice Address - Street 1:6420 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-8202
Practice Address - Fax:314-768-7145
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107057207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO118773OtherBLUE CROSS BLUE SHIELD
MO29381OtherGROUP HEALTH PLAN
MO042938OtherHEALTH ALLIANCE
MO1101500OtherUNITED HEALTH CARE
MO388977OtherHEALTHLINK
MOF43482OtherMERCY
MO1101500OtherUNITED HEALTH CARE