MEDICARE: DR. JEFFREY L PIONTEK M.D.

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	207Q00000X	Family Medicine Physician	36560	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477595684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY L PIONTEK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1500
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-1500
Country	:	US
Telephone Number	:	573-302-2840
Fax Number	:	573-302-2841

Provider Business Practice Location Address
First Line	:	1870 BAGNELL DAM BLVD
Second Line	:
City	:	LAKE OZARK
State	:	MO
Zip	:	65049-8658
Country	:	US
Telephone Number	:	573-365-2318
Fax Number	:	573-365-3009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	01/27/2017

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