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General NPI Number Information
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NPI Number | 1518517028
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Entity Type | Individual
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Provider Name | EDUARDO JACOBS
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Gender | Male
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 42301 MOUND RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-3148
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Country | US
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Telephone | 586-557-4441
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1465
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City | WARREN
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State | MI
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Zip | 48090-1465
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Country | US
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Telephone | 586-557-4441
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301097822
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License Number State | MI
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