Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 43863 | WI |
Y | 207VG0400X | Gynecologist | 43863 | WI |
NPI | 1104828151 |
---|---|
Provider Name | Jeffrey E Rodzak |
First Address | Madison, WI 53703-3378 |
Second Address | Madison, WI 53703-3378 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 12/07/2021 |