Provider Demographics
NPI:1982604930
Name:ONIK, JAN F (DO)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:F
Last Name:ONIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISIANA
Mailing Address - State:MO
Mailing Address - Zip Code:63353-2000
Mailing Address - Country:US
Mailing Address - Phone:573-754-5555
Mailing Address - Fax:573-754-4077
Practice Address - Street 1:211 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISIANA
Practice Address - State:MO
Practice Address - Zip Code:63353-2000
Practice Address - Country:US
Practice Address - Phone:573-754-5555
Practice Address - Fax:573-754-4077
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5C36207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241712710Medicaid
MO241712728Medicaid
MO005010628Medicare ID - Type UnspecifiedLOUISIANA OFFICE
MO241712728Medicaid
MO241712710Medicaid