1811063100 NPI number — TODD J JANUS PHD, MD

Table of content: TODD J JANUS PHD, MD (NPI 1811063100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811063100 NPI number — TODD J JANUS PHD, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANUS
Provider First Name:
TODD
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD, MD
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:
1811063100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8558 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46410-7032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-392-7084
Provider Business Mailing Address Fax Number:
219-703-6854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 S LAKE PARK AVE STE 1103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOBART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46342-6641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-947-6960
Provider Business Practice Location Address Fax Number:
219-947-6961
Provider Enumeration Date:
11/28/2006

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: 2084N0400X , with the licence number:  28416 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 01053537A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300074870 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00424511 . This is a "RR MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 2079723 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811063100 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com