Basic Information
| Provider Information | |||||||||
| NPI: | 1851374904 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLANIUK | ||||||||
| FirstName: | JANUSZ | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 795083 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631790795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008995757 | ||||||||
| FaxNumber: | 3148211833 | ||||||||
| Practice Location | |||||||||
| Address1: | 6420 CLAYTON RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147688202 | ||||||||
| FaxNumber: | 3147687145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 107057 | MO | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 118773 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER | 29381 | 01 | MO | GROUP HEALTH PLAN | OTHER | 042938 | 01 | MO | HEALTH ALLIANCE | OTHER | 1101500 | 01 | MO | UNITED HEALTH CARE | OTHER | 388977 | 01 | MO | HEALTHLINK | OTHER | F43482 | 01 | MO | MERCY | OTHER |