Provider Demographics
NPI:1215990270
Name:JANKOWSKI, RONALD JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:JANKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2610 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2911
Mailing Address - Country:US
Mailing Address - Phone:612-781-6816
Mailing Address - Fax:612-781-3837
Practice Address - Street 1:2610 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-2911
Practice Address - Country:US
Practice Address - Phone:612-781-6816
Practice Address - Fax:612-781-3837
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN21043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN556577400Medicaid
MNA96581Medicare UPIN
MN080015629Medicare Oscar/Certification