Healthcare Provider Details

I. General information

NPI: 1851948889
Provider Name (Legal Business Name): JACOB JOHN PLATT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK ST STE 3280
ELMHURST IL
60126-5638
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9095
  • Fax:
Mailing address:
  • Phone: 847-982-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085008161
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085008161
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: