Provider Demographics
NPI:1245257211
Name:JANOSIK, DENISE L (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:JANOSIK
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 1:625 S. NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 2030
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-251-1700
Mailing Address - Fax:314-251-1701
Practice Address - Street 1:625 S. NEW BALLAS ROAD
Practice Address - Street 2:SUITE 2030
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-1700
Practice Address - Fax:314-251-1701
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1C08207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00776604OtherRAILROAD MEDICARE
MO1245257211Medicaid
MO202464300Medicaid
MO202464300Medicaid
MOP00776604OtherRAILROAD MEDICARE
MOMA1160009Medicare PIN