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General NPI Number Information
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NPI Number | 1174624415
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Entity Type | Individual
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Provider Name | JACOB STEPHEN M.D
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 1850 GATEWAY DR
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City | SYCAMORE
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State | IL
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Zip | 60178-3192
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Country | US
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Telephone | 630-232-0280
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Fax | 630-232-3895
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Provider Business Mailing Address
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Address Line | 5 KISH HOSPITAL DR STE 103
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City | DEKALB
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State | IL
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Zip | 60115-9602
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Country | US
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Telephone | 630-232-0280
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Fax | 630-232-3895
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35.083380
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 036133593
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License Number State | IL
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