Provider Demographics
NPI:1265525711
Name:JANASEK, MITCHELL J (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:J
Last Name:JANASEK
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 1:758 PIONEER PL
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5954
Mailing Address - Country:US
Mailing Address - Phone:970-420-0358
Mailing Address - Fax:
Practice Address - Street 1:1230 14TH ST SW
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-6324
Practice Address - Country:US
Practice Address - Phone:970-619-3999
Practice Address - Fax:970-619-3997
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C491358Medicare PIN
H80163Medicare UPIN