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NPI Code Detail

MEDICARE: PAUL ANDERS JACOBSON M.D.

MEDICARE: PAUL ANDERS JACOBSON M.D.
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
1207XS0106XOrthopaedic Hand Surgery Physician4301076134MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20B81023OTHERMIBCBSM

General Provider Information

NPI Number : 1629074190
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL ANDERS JACOBSON M.D.
Provider Business Mailing Address
First Line : 701 W FRONT ST
Second Line : SUITE 100
City : TRAVERSE CITY
State : MI
Zip : 49684-2236
Country : US
Telephone Number : 231-935-0800
Fax Number : 231-935-0808
Provider Business Practice Location Address
First Line : 701 W FRONT ST
Second Line : SUITE 100
City : TRAVERSE CITY
State : MI
Zip : 49684-2236
Country : US
Telephone Number : 231-935-0800
Fax Number : 231-935-0808
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 10/22/2020

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