Central Otologic LTD
Organization Active NPI Otolaryngology Physician · Delafield, WI
NPI 1659330736 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1659330736
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- Legal business name
- CENTRAL OTOLOGIC LTD
- Practice address
- 2750 Golf Road
Delafield, WI 53018 - Phone
- (262) 928-7055
- NPI assigned
- Mar 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Charles Janowak, MD
- Title
- President
- Phone
- (262) 567-0505
Other NPIs on the same Medicare enrollment 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040609000823 | WI | Part B Supplier - Clinic/Group Practice | 0547243800 |
Receives reassigned benefits from 2 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Oconomowoc, WI; Watertown, WI |
National Provider Directory
Locations
888 Thackeray Trl
Ste 108
Oconomowoc, WI 53066
Phone (262) 567-0505
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician |
207Y00000X | Yes |
Addresses
Primary practice location
2750 Golf Road
Delafield, WI 53018
Mailing address
888 Thackeray Trail
Ste 108
Oconomowoc, WI 53066
Phone (262) 567-0505
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32684000 | Medicaid | WI | |
| 567627 | Other | WI | DEAN HEALTH |
Other providers in Delafield, WI
- Bubon & Associates, Orthodontics, SC
- Angela Byers
- Jaime C Cain
- Cdi Delafield LLC
- Center for Flourishing
- Kirsten Cerroni
- Childllc
- Children'S Health System
- Children'S Medical Group, Inc.
- Craig D. Childs
All providers in Delafield, WI · Otolaryngology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.