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NPI Code Detail

MEDICARE: JACOB PODLESKI

MEDICARE: JACOB PODLESKI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician2017007787MO

General Provider Information

NPI Number : 1003252503
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB PODLESKI
Provider Business Mailing Address
First Line : PO BOX 3810
Second Line :
City : JOPLIN
State : MO
Zip : 64803-3810
Country : US
Telephone Number : 417-347-1078
Fax Number :
Provider Business Practice Location Address
First Line : 1500 N OAKLAND AVE
Second Line :
City : BOLIVAR
State : MO
Zip : 65613-3011
Country : US
Telephone Number : 417-326-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2013
Last Update Date : 06/01/2026

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Directions to “ JACOB PODLESKI ” Practice Location

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