Basic Information
| Provider Information | |||||||||
| NPI: | 1063078830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JANIK | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6480 ANNIE OAKLEY DR UNIT 314 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891203955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9172446000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9300 W SUNSET RD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891484844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029165000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2019 | ||||||||
| LastUpdateDate: | 05/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NV | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.