Provider Demographics
NPI:1770552689
Name:KENGIS, JANIS (MD)
Entity type:Individual
Prefix:DR
First Name:JANIS
Middle Name:
Last Name:KENGIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE #212
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-544-8622
Mailing Address - Fax:262-544-8630
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE #212
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-544-8622
Practice Address - Fax:262-544-8630
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI16999-020207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1770552689Medicaid
WI000268085Medicare PIN
WI1770552689Medicaid