Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 72955 | MA |
NPI | 1194792630 |
---|---|
Provider Name | Milos Josef Janicek |
First Address | Boston, MA 02118-2371 |
Second Address | Boston, MA 02118-2658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 05/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110049795A | (05) | MA |