Individual
DR. DANIEL RAYMOND JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1413 W LEXINGTON ST, CHICAGO, IL 60607-4013
(312) 421-1226
(312) 421-1133
Mailing address
1413 W LEXINGTON ST, CHICAGO, IL 60607-4013
(312) 421-1133
(312) 421-1133
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036075975
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036075975
PHYSICIAN LICENSE
IL
Enumeration date
11/10/2005
Last updated
11/16/2020
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