Individual
MR. JACOB JONATHAN WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5645 W ADDISON ST, CHICAGO, IL 60634-4403
(773) 282-7000
Mailing address
5645 W ADDISON ST, CHICAGO, IL 60634-4403
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085005589
IL
Other
Enumeration date
08/05/2015
Last updated
08/05/2015
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