Individual
MADELYN J JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4950 NORTON HEALTHCARE BLVD, STE 100, LOUISVILLE, KY 40241-2845
(502) 394-6200
(502) 394-6210
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19774
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000350622
ANTHEM - CMA
KY
01
—
000052154N
HUMANA - CMA
KY
01
—
017347
SIHO - CMA
KY
01
—
1198337
CHA - CMA
KY
01
—
2448228000
PASSPORT ADVTG - CMA
KY
01
—
50007053
PASSPORT - CMA
KY
05
—
64197742
—
KY
01
—
6980512-006
CIGNA - CMA
KY
01
—
P00176889
RAILROAD MEDICARE
KY
Enumeration date
04/20/2006
Last updated
09/02/2021
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