Healthcare Provider Details

I. General information

NPI: 1992143705
Provider Name (Legal Business Name): JEFFREY D JACOBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 E BELVIDERE RD STE 311
GRAYSLAKE IL
60030-2016
US

IV. Provider business mailing address

1475 E BELVIDERE RD STE 311
GRAYSLAKE IL
60030-2016
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-6083
  • Fax: 224-271-4910
Mailing address:
  • Phone: 847-535-6083
  • Fax: 224-271-4910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036140402
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD60749315
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: