Organization
THOMAS E. JACOB, D.P.M., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANNETTE M. LINGEMAN (OFFICE MANAGER)
(586) 779-1160
Entity
Organization
Contact information
Practice address
23700 GRATIOT AVE, EASTPOINTE, MI 48021-1647
(586) 779-1160
(586) 779-1163
Mailing address
23700 GRATIOT AVE, EASTPOINTE, MI 48021-1647
(586) 779-1160
(586) 779-1163
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
59010000499
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000002745
CAPE HEALTH PLAN
MI
01
—
0737520001
DME MEDICARE
MI
01
—
101301
GREAT LAKES HEALTH PLAN
MI
01
—
1014915-0001
WELLNESS PLAN
MI
01
—
121471
CARE CHOICE HMO
MI
Enumeration date
10/11/2005
Last updated
08/22/2020
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