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General NPI Number Information
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NPI Number | 1548081961
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Entity Type | Individual
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Provider Name | JACOB KRASNER PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 1820 W WEBSTER AVE STE 304
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City | CHICAGO
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State | IL
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Zip | 60614-4892
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Country | US
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Telephone | 773-253-9002
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Fax |
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Provider Business Mailing Address
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Address Line | 2052 W SHAKESPEARE AVE APT 1R
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City | CHICAGO
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State | IL
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Zip | 60647-4588
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Country | US
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Telephone | 908-510-7111
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.010841
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License Number State | IL
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