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Individual

DR. CAROLYN JACOB

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
515 N STATE ST STE 900, CHICAGO, IL 60654
(312) 245-9965
(312) 245-9964
Mailing address
515 N STATE ST STE 900, CHICAGO, IL 60654-9104
(312) 245-9965
(312) 245-9964

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036102098
IL
207NS0135X
Procedural Dermatology Physician
036102098
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036102098
IL
Enumeration date
04/21/2006
Last updated
02/05/2020
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