Provider Demographics
NPI:1306843321
Name:JACOBS, LOIS JEAN (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:JEAN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 ARBORETUM DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2790
Mailing Address - Country:US
Mailing Address - Phone:920-231-5313
Mailing Address - Fax:920-231-5348
Practice Address - Street 1:1510 ARBORETUM DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2790
Practice Address - Country:US
Practice Address - Phone:920-231-5313
Practice Address - Fax:920-231-5348
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30302207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI202960478012OtherBCBSWI
WI31609600Medicaid
WI31609600Medicaid
WI000071323Medicare ID - Type Unspecified