Individual provider Active NPI

Nicole Marie Janowicz, D.O.

  • General Practice Physician
  • Warren, MI
National Provider Identifier
1609196500
Registry record updated Jun 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
5101018815 Issued in MI
Practice address
12000 E 12 Mile Rd
Warren, MI 48093-3570
Phone
(586) 576-4140
Fax
(586) 576-4146
NPI assigned
Jun 3, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 5101018815 MI Primary

Addresses

Primary practice location

12000 E 12 Mile Rd
Warren, MI 48093-3570

Mailing address

12000 E 12 Mile Rd
Warren, MI 48093-3570
Phone (586) 576-4140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101018815MIMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health Macomb-Oakland Hospital Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275523200000",
    "number": "1609196500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933570",
            "telephone_number": "586-576-4140",
            "fax_number": "586-576-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933570",
            "telephone_number": "586-576-4140",
            "fax_number": "586-576-4146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANOWICZ",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-03",
        "last_updated": "2010-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "5101018815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.