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
Fax: (630) 893-8564
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831136019 NPPES
Illinois MEDICAID 036-110462
Illinois Other CN4921
Illinois Other 209398

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