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NPI Code Detail

MEDICARE: JACOB ROBERT AHLES DO

MEDICARE: JACOB ROBERT AHLES DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician5151014491MI

General Provider Information

NPI Number : 1104449552
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB ROBERT AHLES DO
Provider Business Mailing Address
First Line : 1221 SOUTH DR
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-3257
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1221 SOUTH DR
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-3257
Country : US
Telephone Number : 800-671-1453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2020
Last Update Date : 06/04/2026

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