Healthcare Provider Details

I. General information

NPI: 1811322720
Provider Name (Legal Business Name): SINCER KURIAN JACOB PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3329 75TH ST FL 1
WOODRIDGE IL
60517-2700
US

IV. Provider business mailing address

2650 RIDGE AVE # 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-646-7000
  • Fax: 630-548-1563
Mailing address:
  • Phone: 847-982-3175
  • Fax: 847-982-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085004738
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: