Provider Demographics
NPI:1659087443
Name:GRIEFF, JAKOB
Entity Type:Individual
Prefix:
First Name:JAKOB
Middle Name:
Last Name:GRIEFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13491 N 1600 EAST RD
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-3432
Mailing Address - Country:US
Mailing Address - Phone:815-584-6586
Mailing Address - Fax:
Practice Address - Street 1:13491 N 1600 EAST RD
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-3432
Practice Address - Country:US
Practice Address - Phone:815-584-6586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program