Healthcare Provider Details

I. General information

NPI: 1831752955
Provider Name (Legal Business Name): JACOB PERKINS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S 1ST ST
CHAMPAIGN IL
61820-7661
US

IV. Provider business mailing address

2300 S 1ST ST
CHAMPAIGN IL
61820-7661
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-9400
  • Fax: 217-383-9694
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number36.004056
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016006027
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: