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Organization
NWI MDVIP LLC
Active
Organization
NWI MDVIP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT A JACOBUS DO (OWNER)
(219) 306-0752
Entity
Organization
Contact information
Practice address
9150 E 109TH AVE STE 2B, CROWN POINT, IN 46307-7686
(219) 213-2947
(219) 310-8175
Mailing address
9150 E 109TH AVE STE 2B, CROWN POINT, IN 46307-7686
(219) 306-0752
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/14/2022
Last updated
11/14/2022
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