Provider Demographics
NPI:1386729937
Name:JANKE, MARILYN R (MD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:R
Last Name:JANKE
Suffix:
Gender:F
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:2530 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4317
Practice Address - Country:US
Practice Address - Phone:940-898-1477
Practice Address - Fax:940-382-4091
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8590208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133527502Medicaid
TX4074198OtherAETNA PIN
TX137751OtherPHCS PIN
1750369203OtherGRP NPI NUMBER
TX00U87ZOtherBCBSTX GRP PIN
TX130105100OtherFIRSTCARE PIN
TX2944627OtherCIGNA PIN
TX45183OtherFIRSTHEALTH PIN
TX748257OtherUHC PIN
TX89660YOtherBCBSTX IND PIN
TX140442810Medicaid
TX133527502Medicaid