Provider Demographics
NPI:1629213210
Name:MEYER, JACOB MATHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:MATHEW
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4036
Mailing Address - Country:US
Mailing Address - Phone:773-277-6589
Mailing Address - Fax:503-522-1240
Practice Address - Street 1:3303 W 26TH ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3011
Practice Address - Country:US
Practice Address - Phone:773-277-6589
Practice Address - Fax:503-494-4473
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106181207Q00000X
IL036-135867207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine