Healthcare Provider Details

I. General information

NPI: 1780328831
Provider Name (Legal Business Name): JACOB ALAN SEIDENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST STE 1C
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

1801 W TAYLOR ST STE 1C
CHICAGO IL
60612-4795
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-3631
  • Fax:
Mailing address:
  • Phone: 312-413-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036.173902
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: