MEDICARE: MS. JANA PODZIMEK 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	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	036-078953	IL

General Provider Information

NPI Number	:	1356314058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANA PODZIMEK D.O.

Provider Business Mailing Address
First Line	:	77 NELSON ST STE 130
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-1941
Country	:	US
Telephone Number	:	315-255-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 NELSON ST STE 130
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-1941
Country	:	US
Telephone Number	:	315-255-3300
Fax Number	:

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

Provider Enumeration Date	:	02/12/2006
Last Update Date	:	08/03/2022

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