Individual
DR. ANGELA RENEE JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
6900 ORCHARD LAKE RD STE 207, WEST BLOOMFIELD, MI 48322-3425
(248) 963-0919
Mailing address
6900 ORCHARD LAKE RD STE 207, WEST BLOOMFIELD, MI 48322-3425
(248) 963-0919
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
5315080074
MI
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5901002584
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124430806
—
MI
Enumeration date
05/29/2014
Last updated
06/15/2022
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