Individual
DR. BRIAN J JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 HOLLISTER DR, SUITE 111, LIBERTYVILLE, IL 60048-5263
(847) 573-9055
(847) 573-1790
Mailing address
1800 HOLLISTER DR, SUITE 111, LIBERTYVILLE, IL 60048-5263
(847) 573-9055
(847) 573-1790
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
36114383
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36114383
—
IL
01
—
P00321248
RAIL ROAD MEDIARE
IL
Enumeration date
04/27/2006
Last updated
03/28/2024
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