Provider Demographics
NPI:1871812081
Name:JANICEK, AMY KAY (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:KAY
Last Name:JANICEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2492 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-9552
Mailing Address - Country:US
Mailing Address - Phone:520-722-8994
Mailing Address - Fax:520-624-0117
Practice Address - Street 1:2492 E RIVER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-9552
Practice Address - Country:US
Practice Address - Phone:520-335-6849
Practice Address - Fax:520-459-2191
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ462552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ366173Medicaid