Individual
POTHEN JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4601 STATE ST, SUITE #210, E ST LOUIS, IL 62205-1359
(618) 874-3700
(618) 874-5031
Mailing address
PO BOX 2228, 4601 STATE ST SUITE #210, E ST LOUIS, IL 62205-1359
(618) 874-3700
(618) 874-5031
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
3648725
IL
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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