Individual
PETER A. JANICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1215 E MICHIGAN AVE, LANSING, MI 48912-1811
(517) 364-2315
(517) 372-1617
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 361-5828
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301062797
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1600111
PHP
MI
05
—
2999549
—
MI
01
—
3003304841
BCBS MI INDIVIDUAL PIN
MI
Enumeration date
06/13/2006
Last updated
09/28/2009
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