Provider Demographics
NPI:1477892917
Name:RICHEY, JACOB M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:M
Last Name:RICHEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:4211 N CICERO AVE SUITE 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1651
Mailing Address - Country:US
Mailing Address - Phone:773-202-8800
Mailing Address - Fax:773-202-8810
Practice Address - Street 1:4211 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1651
Practice Address - Country:US
Practice Address - Phone:773-202-8800
Practice Address - Fax:773-202-8810
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL016005679213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery