Provider Demographics
NPI:1639171754
Name:JANICEK, MIKE FRANZ (MD)
Entity type:Individual
Prefix:MR
First Name:MIKE
Middle Name:FRANZ
Last Name:JANICEK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1760 E RIVER RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5877
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:10197 N 92ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4560
Practice Address - Country:US
Practice Address - Phone:480-993-2950
Practice Address - Fax:480-993-2957
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2018-03-07
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Provider Licenses
StateLicense IDTaxonomies
AZAZ26273207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ422527Medicaid
AZZ126378Medicare PIN
AZZ21895Medicare PIN