Provider Demographics
NPI:1932228038
Name:JANKUS, WARD RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:WARD
Middle Name:RAYMOND
Last Name:JANKUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3448
Mailing Address - Country:US
Mailing Address - Phone:920-751-8897
Mailing Address - Fax:
Practice Address - Street 1:704 S PARK AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3448
Practice Address - Country:US
Practice Address - Phone:920-751-8897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35146208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation