Individual
JEFFREY RANDALL JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
909 SOUTH WOLCOTT AVENUE, 3141 COMRB, CHICAGO, IL 60612-3725
(312) 996-8039
(312) 996-4665
Mailing address
909 SOUTH WOLCOTT AVENUE, 3141 COMRB, CHICAGO, IL 60612-3725
(312) 996-8039
(312) 996-4665
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036.114116
IL
207RP1001X
Pulmonary Disease Physician
Primary
036.114116
IL
207RP1001X
Pulmonary Disease Physician
036114116
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114116
—
IL
Enumeration date
12/13/2006
Last updated
03/04/2010
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