Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 036058908 | IL |
NPI | 1669475794 |
---|---|
Provider Name | Dr. Raymond V Janevicius |
First Address | Warrenville, IL 60555-4025 |
Second Address | Elmhurst, IL 60126-5634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 14/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C44426 | (02) | IL |