MEDICARE: JANE L. KJOLLER, MD

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
1	207R00000X	Internal Medicine Physician	60194237	NY

General Provider Information

NPI Number	:	1265624043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE L. KJOLLER, MD

Provider Business Mailing Address
First Line	:	26 S GOODMAN ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-2078
Country	:	US
Telephone Number	:	585-244-0674
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 S GOODMAN ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-2078
Country	:	US
Telephone Number	:	585-244-0674
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JANE L KJOLLER
Credential	:	MD
Telephone Number	:	585-244-0674

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	04/22/2008

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