Provider Demographics
NPI:1194811430
Name:JANAS-KAMINSKY, JOANNA E (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:E
Last Name:JANAS-KAMINSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:#2 SAINT ANTHONY'S WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4569
Mailing Address - Country:US
Mailing Address - Phone:618-465-8019
Mailing Address - Fax:618-463-5004
Practice Address - Street 1:#2 SAINT ANTHONY'S WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4569
Practice Address - Country:US
Practice Address - Phone:618-465-8019
Practice Address - Fax:618-463-5004
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099727207R00000X
IL036-099727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099727Medicaid
ILG99948Medicare UPIN
ILL82971Medicare ID - Type Unspecified