Healthcare Provider Details

I. General information

NPI: 1427290055
Provider Name (Legal Business Name): LUKE A JAKUBOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 S 56TH ST APT 11
MILWAUKEE WI
53219-3182
US

IV. Provider business mailing address

2530 CHICAGO AVENUE SOUTH CHILDRENS SPECIALTY CENTER SUITE 450
MINNEAPOLIS MN
55404
US

V. Phone/Fax

Practice location:
  • Phone: 608-359-6964
  • Fax:
Mailing address:
  • Phone: 612-874-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number59156
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: