Individual
DR. DENNIS M JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
495 ELLIOT CREEK DR, CARMEL, IN 46032-6331
(317) 999-9999
Mailing address
495 ELLIOT CREEK DR, CARMEL, IN 46032-6331
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
01033979
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100366930A
—
IN
01
—
P01198024
RR MEDICARE PTAN
IN
Enumeration date
07/06/2006
Last updated
02/05/2026
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