Provider Demographics
NPI:1285601070
Name:JANOWAK, MICHAEL CHARLES (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:JANOWAK
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:888 THACKERAY TRL
Mailing Address - Street 2:STE 108
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:262-567-0505
Mailing Address - Fax:262-567-0778
Practice Address - Street 1:888 THACKERAY TRL
Practice Address - Street 2:STE 108
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4342
Practice Address - Country:US
Practice Address - Phone:262-567-0505
Practice Address - Fax:262-567-0778
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2013-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI18235207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI040004256OtherRAILROAD MEDICARE
WI000102385OtherMEDICARE
WI1004201OtherPHYSICIANS PLUS
WI30102900Medicaid
WI777OtherDEAN HEALTH PLAN
WI000168715OtherMEDICARE
WI000102385OtherMEDICARE
WI040004256OtherRAILROAD MEDICARE