Provider Demographics
NPI:1750739256
Name:JANEK, KEVIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:JANEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-563-6530
Mailing Address - Fax:505-224-7479
Practice Address - Street 1:201 CEDAR ST SE STE 4660
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4924
Practice Address - Country:US
Practice Address - Phone:505-563-6530
Practice Address - Fax:505-224-7479
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2025-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2025-06962086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery