Provider Demographics
NPI:1972539625
Name:JANKOWSKI, KAREN E (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:JANKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:J
Other - Last Name:FRUECHTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2001 BLOOMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3074
Mailing Address - Country:US
Mailing Address - Phone:612-301-3433
Mailing Address - Fax:612-627-4205
Practice Address - Street 1:2001 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3074
Practice Address - Country:US
Practice Address - Phone:612-301-3433
Practice Address - Fax:612-627-4205
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013008Medicaid
NH30206288Medicaid
NH7504457OtherCIGNA
NH4152341OtherMVP
VT00069534OtherBC/BS VT
VT1013008Medicaid