MEDICARE: DR. JODI L WIKTOROWSKI D.V.M.

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	174M00000X	Veterinarian	5823	OR

General Provider Information

NPI Number	:	1700126935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODI L WIKTOROWSKI D.V.M.

Provider Business Mailing Address
First Line	:	2555 MOSBY CREEK RD
Second Line	:
City	:	COTTAGE GROVE
State	:	OR
Zip	:	97424-1777
Country	:	US
Telephone Number	:	541-942-9132
Fax Number	:	541-942-9134

Provider Business Practice Location Address
First Line	:	2555 MOSBY CREEK RD
Second Line	:
City	:	COTTAGE GROVE
State	:	OR
Zip	:	97424-1777
Country	:	US
Telephone Number	:	541-942-9132
Fax Number	:	541-942-9134

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

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	02/25/2013

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