Organization
W JACOBSEN DPM PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER JOSEPH JACOBSEN DPM (PRESIDENT)
(773) 561-7626
Entity
Organization
Contact information
Practice address
1126 W BRYN MAWR AVE, CHICAGO, IL 60660-4410
(773) 561-7626
(773) 561-1111
Mailing address
1126 W BRYN MAWR AVE, CHICAGO, IL 60660-4410
(773) 561-7626
(773) 561-1111
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016004485
IL
Other
Enumeration date
04/14/2008
Last updated
11/09/2010
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