MEDICARE: DR. CHRISTOPHER RICHARD JODLOWSKI 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	30966	NE
2	207L00000X	Anesthesiology Physician	0101238642	VA

General Provider Information

NPI Number	:	1134182868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER RICHARD JODLOWSKI M.D.

Provider Business Mailing Address
First Line	:	7261 MERCY RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-2311
Country	:	US
Telephone Number	:	402-717-4866
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 MERCY RD STE 1355
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124
Country	:	US
Telephone Number	:	402-717-4866
Fax Number	:

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	08/07/2018

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