MEDICARE: JOHN R. JAKUBEK M.D.

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
1	207L00000X	Anesthesiology Physician	35-049919	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050028962	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144266867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN R. JAKUBEK M.D.

Provider Business Mailing Address
First Line	:	4135 BOARDMAN CANFIELD RD
Second Line	:	SUITE 101
City	:	CANFIELD
State	:	OH
Zip	:	44406-9803
Country	:	US
Telephone Number	:	330-286-5330
Fax Number	:	330-286-5396

Provider Business Practice Location Address
First Line	:	4147 WESTFORD DR
Second Line	:
City	:	CANFIELD
State	:	OH
Zip	:	44406-8086
Country	:	US
Telephone Number	:	330-702-1489
Fax Number	:	330-702-1545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	09/22/2014

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