Organization
CENTRAL OTOLOGIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CHARLES JANOWAK MD (PRESIDENT)
(262) 567-0505
Entity
Organization
Contact information
Practice address
888 THACKERAY TRAIL, SUITE # 108, OCONOMOWOC, WI 53066
(262) 567-0505
(262) 567-0778
Mailing address
888 THACKERAY TRAIL, SUITE # 108, OCONOMOWOC, WI 53066
(262) 567-0505
(262) 567-0778
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32684000
—
WI
01
—
551343
DEAN HEALTH PLAN
WI
01
—
C01716
RAILROAD MEDICARE
WI
Enumeration date
02/21/2006
Last updated
08/22/2020
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