Provider Demographics
NPI:1366586893
Name:JANKOWSKI, EDWARD G (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
Last Name:JANKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20867 MACK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1392
Mailing Address - Country:US
Mailing Address - Phone:313-884-4080
Mailing Address - Fax:313-884-3769
Practice Address - Street 1:20867 MACK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1392
Practice Address - Country:US
Practice Address - Phone:313-884-4080
Practice Address - Fax:313-884-3769
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIEJ048196207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2826242Medicaid
MI2826242Medicaid
MIA76257Medicare UPIN