Provider Demographics
NPI:1245403492
Name:LOUIS JACOBS, D.O., P.C.
Entity Type:Organization
Organization Name:LOUIS JACOBS, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ISRAEL
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-421-0044
Mailing Address - Street 1:6245 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-4001
Mailing Address - Country:US
Mailing Address - Phone:734-421-0044
Mailing Address - Fax:734-458-3364
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:SUITE 206
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-421-0044
Practice Address - Fax:734-458-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILJ006797207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1367083Medicaid
MI5821167OtherBCBSM
MI5821167OtherBCBSM
MI58200916141Medicare PIN