Provider Demographics
NPI:1427260959
Name:JANICKI, JOSEPH ALOYSIUS (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALOYSIUS
Last Name:JANICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:BOX #69
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-6190
Mailing Address - Fax:312-227-9404
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:BOX #69
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6190
Practice Address - Fax:312-227-9404
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.118217207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118217Medicaid
IL1627123OtherBCBS PROVIDER ID
IL1627123OtherBCBS PROVIDER ID