MEDICARE: JENNIFER LYNN KOLODCHAK 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	207P00000X	Emergency Medicine Physician	ME107844	FL

General Provider Information

NPI Number	:	1942276985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN KOLODCHAK M.D.

Provider Business Mailing Address
First Line	:	376 LANTERNBACK ISLAND DR
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-4707
Country	:	US
Telephone Number	:	321-698-3839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 N SEMORAN BLVD STE 100
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3568
Country	:	US
Telephone Number	:	321-804-9110
Fax Number	:

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	10/31/2022

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