Healthcare Provider Details

I. General information

NPI: 1437592250
Provider Name (Legal Business Name): JACOB MATHIAS HAKKOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 12/21/2019
Certification Date: 12/21/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W BARAGA AVE
MARQUETTE MI
49855-4550
US

IV. Provider business mailing address

850 W. BARAGA AVENUE INTERVENTIONAL RADIOLOGY - SUITE 20
MARQUETTE MI
49855
US

V. Phone/Fax

Practice location:
  • Phone: 906-449-3495
  • Fax: 906-449-1939
Mailing address:
  • Phone: 906-449-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301500444
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: