Provider Demographics
NPI:1811063100
Name:JANUS, TODD J (PHD, MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:J
Last Name:JANUS
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:1600 S LAKE PARK AVE STE 1103
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6641
Practice Address - Country:US
Practice Address - Phone:219-947-6960
Practice Address - Fax:219-947-6961
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA284162084N0400X
IN01053537A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300074870Medicaid
IAP00424511OtherRR MEDICARE
IA2079723Medicaid
IA1811063100Medicaid
IAP00424511OtherRR MEDICARE