Individual
MARK B JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1893 SHERIDAN RD STE 311, HIGHLAND PARK, IL 60035-2646
(847) 433-6636
(847) 433-2090
Mailing address
809 S MARSHFIELD AVE, 9TH FLOOR (M/C 732), CHICAGO, IL 60612-4305
(312) 996-7699
(312) 996-1001
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
021.002059
IL
Other
Enumeration date
08/20/2006
Last updated
12/28/2023
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