Provider Demographics
NPI:1114902483
Name:JACOBSON, REBECCA E (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:E
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:E
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:773-905-3288
Mailing Address - Fax:
Practice Address - Street 1:900 N WESTMORELAND RD
Practice Address - Street 2:STE 228
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1674
Practice Address - Country:US
Practice Address - Phone:847-234-3860
Practice Address - Fax:847-234-3981
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109162207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH90608Medicare UPIN
ILK00226Medicare ID - Type Unspecified