Individual
DR. JOSHUA J. JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1611 W HARRISON ST, STE 400, CHICAGO, IL 60612-3841
(312) 243-4244
(312) 942-1517
Mailing address
1 WESTBROOK CORPORATE CTR, SUITE #240, WESTCHESTER, IL 60154-5701
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
036074410
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036074410 4
—
IL
01
—
1633878
BCBS GROUP ID#
IL
01
—
207067
MEDICARE LOCALITY #16
IL
01
—
207073
MEDICARE LOCALITY #15
IL
01
—
4122842
AETNA ID#
IL
01
—
DA4902
RR MEDICARE PTAN#
IL
01
—
P00094334
RR MEDICARE ID#
IL
Enumeration date
01/10/2006
Last updated
09/18/2018
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