Healthcare Provider Details

I. General information

NPI: 1740476860
Provider Name (Legal Business Name): JONATHAN JACOBS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12140 NALL AVE SUITE 100
OVERLAND PARK KS
66209-2503
US

IV. Provider business mailing address

12140 NALL AVE SUITE 100
OVERLAND PARK KS
66209-2503
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-8500
  • Fax: 913-451-8526
Mailing address:
  • Phone: 913-451-8500
  • Fax: 913-451-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN TODD JACOBS
Title or Position: OWNER
Credential: MD
Phone: 913-451-8500