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General NPI Number Information
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NPI Number | 1841210457
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Entity Type | Organization
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Legal Business Name | JACOBSON MEDICAL SERVICES SC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 4440 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2600
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Country | US
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Telephone | 708-684-8000
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Fax | 312-421-1133
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Provider Business Mailing Address
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Address Line | 1413 W. LEXINGTON
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City | CHICAGO
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State | IL
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Zip | 60607-4013
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Country | US
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Telephone | 312-421-1226
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Fax | 312-421-1133
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL RAYMOND JACOBSON
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Credential | MD
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Telephone | 312-421-1226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 042-618125
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License Number State | IL
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