Provider Demographics
NPI:1205863792
Name:MOSKOVIC, JACOB L (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:L
Last Name:MOSKOVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 S WILKE RD STE 226
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1530
Mailing Address - Country:US
Mailing Address - Phone:847-590-0050
Mailing Address - Fax:847-590-0080
Practice Address - Street 1:121 S WILKE RD STE 226
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1530
Practice Address - Country:US
Practice Address - Phone:847-590-0050
Practice Address - Fax:847-590-0080
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0409892084P0802X, 2084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36040989Medicaid
IL36040989Medicaid
ILC41372Medicare UPIN