Provider Demographics
NPI:1275823296
Name:JACOBS, KRISTIN MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST STE 1138
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3845
Mailing Address - Country:US
Mailing Address - Phone:312-563-6000
Mailing Address - Fax:312-563-6008
Practice Address - Street 1:1725 W HARRISON ST STE 1138
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-563-6000
Practice Address - Fax:312-563-6008
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD15052207V00000X
IL036-0147049207V00000X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology