Provider Demographics
NPI:1619950169
Name:JACOBS, MICHAEL A (MD PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 BURNS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4327
Mailing Address - Country:US
Mailing Address - Phone:561-624-9797
Mailing Address - Fax:561-624-0416
Practice Address - Street 1:3370 BURNS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4327
Practice Address - Country:US
Practice Address - Phone:561-624-9797
Practice Address - Fax:561-624-0416
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066801208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26548Medicare ID - Type Unspecified
E54644Medicare UPIN