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Organization
LIBERTYVILLE ANKLE & FOOT CLINIC, INC
Active
Organization
LIBERTYVILLE ANKLE & FOOT CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT A JACOBSEN DPM (OWNER)
(847) 362-1320
Entity
Organization
Contact information
Practice address
1017 W PARK AVE, SUITE A, LIBERTYVILLE, IL 60048-2502
(847) 362-1320
(847) 362-1823
Mailing address
1017 W PARK AVE, SUITE A, LIBERTYVILLE, IL 60048-2502
(847) 362-1320
(847) 362-1823
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016-005031
IL
Other
Enumeration date
12/21/2005
Last updated
07/25/2014
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