Provider Demographics
NPI:1689780017
Name:JAKOB, HARRIET ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:ANNE
Last Name:JAKOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:M2 ANNEX
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-8530
Mailing Address - Fax:216-444-8530
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:M2 ANNEX
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-8530
Practice Address - Fax:216-444-8530
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-067303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0157011Medicaid
F56491Medicare UPIN
0783124Medicare PIN