Provider Demographics
NPI:1396749628
Name:JANUSZ, ALEX J (DO)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:J
Last Name:JANUSZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:451 HIDDEN MEADOWS DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9812
Mailing Address - Country:US
Mailing Address - Phone:517-437-8366
Mailing Address - Fax:517-437-8362
Practice Address - Street 1:451 HIDDEN MEADOWS DR
Practice Address - Street 2:SUITE 230
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9812
Practice Address - Country:US
Practice Address - Phone:517-437-8366
Practice Address - Fax:517-437-8362
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34007800J2084N0400X
IN02002467A2084N0400X
MI510101134802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2479376Medicaid
INH59499Medicare UPIN
OH4145291Medicare PIN
OH2479376Medicaid