MEDICARE: DR. JEFFERY DAVID KOWITZ DVM

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	174M00000X	Veterinarian	3585	WI

General Provider Information

NPI Number	:	1659663524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY DAVID KOWITZ DVM

Provider Business Mailing Address
First Line	:	211 W BENDER RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-4301
Country	:	US
Telephone Number	:	414-962-8040
Fax Number	:	414-962-9441

Provider Business Practice Location Address
First Line	:	211 W BENDER RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-4301
Country	:	US
Telephone Number	:	414-962-8040
Fax Number	:	414-962-9441

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

Provider Enumeration Date	:	05/10/2011
Last Update Date	:	05/10/2011

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