MEDICARE: JESSICA RETZKE 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	208000000X	Pediatrics Physician	35.091075	OH
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	35.091075	OH

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	:	1194986430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RETZKE M.D.

Provider Business Mailing Address
First Line	:	700 CHILDREN'S DRIVE
Second Line	:	SUITE A
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2664
Country	:	US
Telephone Number	:	614-722-6200
Fax Number	:	614-722-5176

Provider Business Practice Location Address
First Line	:	4560 MORSE CENTRE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-6602
Country	:	US
Telephone Number	:	614-722-6200
Fax Number	:

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

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	10/03/2025

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