1851374904 NPI number — JANUSZ WOLANIUK M.D.

Table of content: JANUSZ WOLANIUK M.D. (NPI 1851374904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851374904 NPI number — JANUSZ WOLANIUK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLANIUK
Provider First Name:
JANUSZ
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851374904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 795083
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63179-0795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-899-5757
Provider Business Mailing Address Fax Number:
314-821-1833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6420 CLAYTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-768-8202
Provider Business Practice Location Address Fax Number:
314-768-7145
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  107057 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 118773 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 29381 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 042938 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1101500 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 388977 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: F43482 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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