Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301093533 | MI |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 4301093533 | MI |
NPI | 1437398831 |
---|---|
Provider Name | Anthony B Janas |
First Address | Battle Creek, MI 49014-5462 |
Second Address | Battle Creek, MI 49014-5462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2009 |
Last Update Date | 06/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104840529 | BCBSM - BRONSON (01) | MI |
1437398831 | (05) | MI |