Provider Demographics
NPI:1598735607
Name:JACOBI, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JACOBI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:STE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4248
Mailing Address - Fax:317-865-8314
Practice Address - Street 1:1225 E COOLSPRING AVE
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-6312
Practice Address - Country:US
Practice Address - Phone:219-878-5037
Practice Address - Fax:219-873-2931
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01027648A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100162940Medicaid
C25134Medicare UPIN