Basic Information
Provider Information
NPI: 1003819269
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JANKOV
FirstName: ALEKSANDAR
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 965 RIDGE LAKE BLVD STE 103
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381209446
CountryCode: US
TelephoneNumber:  
FaxNumber: 9012278591
Practice Location
Address1: 6029 WALNUT GROVE RD
Address2: SUITE 301
City: MEMPHIS
State: TN
PostalCode: 381202112
CountryCode: US
TelephoneNumber: 9017479081
FaxNumber: 9017479087
Other Information
ProviderEnumerationDate: 05/23/2005
LastUpdateDate: 06/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/22/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X18181MSN Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
207RH0003X37030TNY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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