Individual
JACOB M CAPITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 962-5975
Mailing address
250 N SHADELAND AVE, SUITE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
(317) 962-5975
(317) 962-4343
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01077807A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0334029
—
OH
Enumeration date
06/11/2015
Last updated
01/16/2024
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