# W JACOBSEN DPM PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801060561
- **Authorized official:** DR. WALTER JOSEPH JACOBSEN DPM (PRESIDENT)
- **Authorized official phone:** (773) 561-7626

## Contact information

- **Practice address:** 1126 W BRYN MAWR AVE, CHICAGO, IL 60660-4410
- **Practice address phone:** (773) 561-7626
- **Practice address fax:** (773) 561-1111
- **Mailing address:** 1126 W BRYN MAWR AVE, CHICAGO, IL 60660-4410
- **Mailing address phone:** (773) 561-7626
- **Mailing address fax:** (773) 561-1111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 016004485 | IL | Yes |

## Other

- **Enumeration date:** 04/14/2008
- **Last updated:** 11/09/2010