Individual
DR. WALTER P JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2901 W KINNICKINNIC RIVER PKWY STE 102, MILWAUKEE, WI 53215-3660
(414) 646-8000
(414) 646-8010
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
02004152A
IN
207T00000X
Neurological Surgery Physician
Primary
67323
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100067137
—
WI
05
—
1649419169
—
WI
01
—
K400387643
MEDICARE
WI
Enumeration date
02/05/2009
Last updated
09/27/2023
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