MEDICARE: JARMILA SLEZKOVA 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	207L00000X	Anesthesiology Physician	002048	NY

General Provider Information

NPI Number	:	1568444651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARMILA SLEZKOVA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 91
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-0091
Country	:	US
Telephone Number	:	315-782-4207
Fax Number	:	315-782-8699

Provider Business Practice Location Address
First Line	:	830 WASHINGTON ST
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-4034
Country	:	US
Telephone Number	:	315-785-8509
Fax Number	:	315-785-8619

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	05/15/2012

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