Doctor Name: | DR. DANIEL RAYMOND JACOBSON |
NPI Number: | 1447231063 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 1413 W Lexington St Chicago, IL - 606074013 |
Business Phone Number: | 3124211226 |
Business Fax Number: | 3124211133 |
Mailing Address: | 1413 W Lexington St, CHICAGO |
State: | IL |
Postal Code: | 606074013 |
Phone Number: | 3124211226 |
Fax Number: | 3124211133 |
NPI Enumeration Date: | 11/10/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |