MEDICARE: JEANETTE KROLIKOWSKI 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	207R00000X	Internal Medicine Physician	20A9312	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20A9312	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1962471920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE KROLIKOWSKI D.O.

Provider Business Mailing Address
First Line	:	PO BOX 60000
Second Line	:	FILE 74175
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94160-0001
Country	:	US
Telephone Number	:	415-641-2177
Fax Number	:	415-641-2190

Provider Business Practice Location Address
First Line	:	1580 VALENCIA ST
Second Line	:	STE 506
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-4423
Country	:	US
Telephone Number	:	415-641-2128
Fax Number	:	415-641-6831

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	08/09/2010

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Directions to “ JEANETTE KROLIKOWSKI D.O.” Practice Location

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