Jacob, Susan
Jacob, Susan is an individual health care provider with primary practice located at 303 E Army Trail Rd Ste 410A, Bloomingdale IL 60108-2169. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Jacob, Susan can be contacted via phone (630) 893-8161.Contact Information
Primary practice address
303 E Army Trail Rd Ste 410A
Bloomingdale IL 60108-2169
Phone: (630) 893-8161
Fax: (630) 893-8564
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036-110462 | Illinois |
Profile Details
| NPI number | 1831136019 |
|---|---|
| LBN Legal business name | Jacob, Susan |
| Credentials | M.C. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 31st, 2006 |
| Last updated | Mar 7th, 2023 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831136019 | NPPES |
| Illinois | MEDICAID | 036-110462 | |
| Illinois | Other | CN4921 | |
| Illinois | Other | 209398 |
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