Provider Demographics
NPI:1891894622
Name:MAERE, JANINE (MD)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:MAERE
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 1:211 LANDMARK DR
Mailing Address - Street 2:SUITE E1
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2160
Mailing Address - Country:US
Mailing Address - Phone:309-268-9304
Mailing Address - Fax:
Practice Address - Street 1:211 LANDMARK DR
Practice Address - Street 2:SUITE E1
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2160
Practice Address - Country:US
Practice Address - Phone:309-268-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105714Medicaid
833120OtherMEDICARE GROUP # FOR BLOOMINGTON
ILL94030Medicare ID - Type UnspecifiedINDIVIDUAL #
IL833610Medicare ID - Type UnspecifiedGROUP #
IL036105714Medicaid
833120OtherMEDICARE GROUP # FOR BLOOMINGTON
IL080189785Medicare ID - Type UnspecifiedRR INDIVIDUAL #
ILCB6569Medicare ID - Type UnspecifiedRR GROUP #