Provider Demographics
NPI:1871696369
Name:POLITZ, JODI S (DPM)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:S
Last Name:POLITZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:STE. 118
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-240-8038
Mailing Address - Fax:702-240-2256
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:STE 118
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-240-8038
Practice Address - Fax:702-240-2256
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9811213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63134Medicare UPIN
NV4089960001Medicare NSC
V34526Medicare ID - Type Unspecified