Provider Demographics
NPI:1992884167
Name:JANIGA, ANTHONY M (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:JANIGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 95TH ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5041
Mailing Address - Country:US
Mailing Address - Phone:630-236-4315
Mailing Address - Fax:630-236-4316
Practice Address - Street 1:1012 95TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5041
Practice Address - Country:US
Practice Address - Phone:630-236-4315
Practice Address - Fax:630-236-4316
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-077825207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL427770Medicare ID - Type Unspecified
ILE67703Medicare UPIN