MEDICARE: DR. MICHAEL DUANE JACOBSON D.O. MPH

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	34. 005720	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1639390651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DUANE JACOBSON D.O. MPH

Provider Business Mailing Address
First Line	:	4222 TYLERSVILLE RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45011-8634
Country	:	US
Telephone Number	:	513-860-1099
Fax Number	:	888-615-8287

Provider Business Practice Location Address
First Line	:	2261 PHILADELPHIA DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-1814
Country	:	US
Telephone Number	:	937-734-6700
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	04/05/2018

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