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General NPI Number Information
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NPI Number | 1275823296
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Entity Type | Individual
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Provider Name | MISS KRISTIN MICHELLE JACOBS
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Gender | Female
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST STE 1138
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-563-6000
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Fax | 312-563-6008
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Provider Business Mailing Address
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Address Line | 1725 W HARRISON ST STE 1138
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City | CHICAGO
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State | IL
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Zip | 60612-3845
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Country | US
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Telephone | 312-563-6000
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Fax | 312-563-6008
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD15052
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036-0147049
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number | 036-0147049
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License Number State | IL
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