Organization
LOIS J JACOBS MD PHD S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOIS J JACOBS MD, PHD (PRESIDENT)
(920) 231-5313
Entity
Organization
Contact information
Practice address
1510 ARBORETUM DR, OSHKOSH, WI 54901-2790
(920) 231-5313
(920) 231-5348
Mailing address
1510 ARBORETUM DR, OSHKOSH, WI 54901-2790
(920) 231-5313
(920) 231-5348
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
30302
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31609600
—
WI
Enumeration date
12/10/2007
Last updated
02/07/2008
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