Jacob, Mark Kevin

Jacob, Mark Kevin is an individual health care provider with primary practice located at 1340 Charles St Ste 401 , Rockford IL 61104-2200. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is his primary health care specialty. Jacob, Mark Kevin can be contacted via phone (779) 696-6102.

Contact Information

Primary practice address
1340 Charles St Ste 401 Rockford IL 61104-2200
Phone: (779) 696-6102
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 4301086585 Michigan
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X 036.161882 Illinois
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X 04-331614 Kansas
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X 04-331614 Kansas
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X 2011-01117 North Carolina

Profile Details

NPI number 1063688497
LBN Legal business name Jacob, Mark Kevin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 6th, 2008
Last updated Dec 27th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063688497 NPPES
North Carolina MEDICAID 5919082
North Carolina Other 1653F

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