Provider Demographics
NPI:1194874560
Name:JANECKI, CHESTER JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:JOSEPH
Last Name:JANECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8496 BARDMOOR PL
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1303
Mailing Address - Country:US
Mailing Address - Phone:813-237-3300
Mailing Address - Fax:813-237-3308
Practice Address - Street 1:4221 N HIMES AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6229
Practice Address - Country:US
Practice Address - Phone:813-237-3300
Practice Address - Fax:813-237-3308
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58487207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC49612Medicare UPIN