Provider Demographics
NPI:1891802344
Name:LOWELL, JANIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:JANIS
Middle Name:A
Last Name:LOWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:525 KENOSHA ST
Practice Address - Street 2:#A
Practice Address - City:WALWORTH
Practice Address - State:WI
Practice Address - Zip Code:53184
Practice Address - Country:US
Practice Address - Phone:262-275-2101
Practice Address - Fax:262-275-0752
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31419100Medicaid
WI31419100Medicaid
BL0521686OtherDEA NUMBER