Ellen a. Janetzke, M.D., P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

EJ066875 Issued in MI

Legal business name

ELLEN A. JANETZKE, M.D., P.C.

Practice address

60 W Big Beaver Rd Ste 100NA
Bloomfield Hills, MI 48304-3909

Phone

(248) 258-5100

Fax

(248) 258-5110

NPI assigned

Nov 28, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ellen A Janetzke, M.DNPI 1235120742

Title

Physician

Phone

(248) 258-5100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ellen Amanda Janetzke, M.D.

  • Specialist
  • Bloomfield Hills, MI
  • NPI 1235120742
  Medicare reassignment NPD Authorized official
• Rebecca Boston, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Bloomfield Hills, MI
  • NPI 1073976213
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621987200000",
    "number": "1598947996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 W BIG BEAVER RD STE 100NA",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483043909",
            "telephone_number": "248-258-5100",
            "fax_number": "248-258-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 W BIG BEAVER RD STE 100NA",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483043909",
            "telephone_number": "248-258-5100",
            "fax_number": "248-258-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN A. JANETZKE, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A",
        "authorized_official_last_name": "JANETZKE",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "248-258-5100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "EJ066875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Estelle Elder, LLPC
• Eleanor Medina MD PC
• Ahmad Talal Elhaouli, DPM
• Elizabeth Eiten LMSW LLC
• Christine Elkhoury, RD, LDN
• Ralph A Ellis, PT
• Nermeen Hassan Elnabtity, D.D.S
• Janice Marie Elsman, MA, LLP
• Richard Elton
• Esmaeil Emami

• Specialist in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.