Individual
DR. JACOB MAXWELL-PHILLIP BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 E DELAWARE PL STE 501, CHICAGO, IL 60611-1666
(312) 549-8691
(312) 549-8692
Mailing address
1 E DELAWARE PL STE 501, CHICAGO, IL 60611-1666
(312) 535-3721
Taxonomy
Speciality
Code
Description
License number
State
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
036134552
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
036134552
IL
Other
Enumeration date
04/16/2008
Last updated
02/19/2025
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