Individual
DR. MARK J JANICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FAAN
Contact information
Practice address
2705 N LEBANON ST STE 265, LEBANON, IN 46052-8621
(765) 485-8830
(765) 485-8839
Mailing address
2605 N LEBANON ST, LEBANON, IN 46052-1476
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01032550A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100068000
—
IN
Enumeration date
07/07/2005
Last updated
10/11/2023
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