MEDICARE: DR. KARINA JANDZISZAK D.O.

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	208000000X	Pediatrics Physician	20993	OK

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	:	1841282399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARINA JANDZISZAK D.O.

Provider Business Mailing Address
First Line	:	1921 STONECIPHER BLVD
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820
Country	:	US
Telephone Number	:	580-421-4570
Fax Number	:	580-421-6283

Provider Business Practice Location Address
First Line	:	1921 STONECIPHER BLVD
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-3439
Country	:	US
Telephone Number	:	580-436-3980
Fax Number	:	580-421-6286

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	09/30/2011

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