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Individual

DR. ALEXIS DANIELLE JACOB

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
700 S PARK ST STE A, MADISON, WI 53715-1830
(608) 260-2900
(608) 260-2961
Mailing address
700 S PARK ST STE A, MADISON, WI 53715-1830
(608) 260-2900
(608) 260-2961

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
BP10023656
TX
2086S0129X
Vascular Surgery Physician
Primary
77962-20
WI
2086S0129X
Vascular Surgery Physician
N6891
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1881924819
WI
Enumeration date
01/14/2010
Last updated
06/12/2023
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