MEDICARE: MATTHEW JACOBS

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	183500000X	Pharmacist	5302039297	MI

General Provider Information

NPI Number	:	1740691500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JACOBS

Provider Business Mailing Address
First Line	:	3955 N US HIGHWAY 31 S
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4495
Country	:	US
Telephone Number	:	231-933-1833
Fax Number	:

Provider Business Practice Location Address
First Line	:	3955 N US HIGHWAY 31 S
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4495
Country	:	US
Telephone Number	:	231-933-1833
Fax Number	:

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

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	05/15/2014

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Directions to “ MATTHEW JACOBS ” Practice Location

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