1447266432 NPI number — JANET TODORCZUK MD

Table of content: JANET TODORCZUK MD (NPI 1447266432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447266432 NPI number — JANET TODORCZUK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TODORCZUK
Provider First Name:
JANET
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1447266432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11525 OLDE CABIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CREVE COEUR
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-7146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-997-0554
Provider Business Mailing Address Fax Number:
314-997-5086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11525 OLDE CABIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CREVE COEUR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-7146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-997-0554
Provider Business Practice Location Address Fax Number:
314-997-5086
Provider Enumeration Date:
07/31/2006

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: 207RG0100X , with the licence number:  R2K13 , 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: 005012657 . This is a "MEDICARE LEGACY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100017273 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20651 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 790731 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 685715 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4118530 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 136158 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202839015 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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