Provider Demographics
NPI:1730146218
Name:JACOBS, BRIAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1800 HOLLISTER DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5263
Mailing Address - Country:US
Mailing Address - Phone:847-573-9055
Mailing Address - Fax:847-573-1790
Practice Address - Street 1:1800 HOLLISTER DR
Practice Address - Street 2:SUITE 111
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5263
Practice Address - Country:US
Practice Address - Phone:847-573-9055
Practice Address - Fax:847-573-1790
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36114383207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36114383Medicaid
ILP00321248OtherRAIL ROAD MEDIARE
IL36114383Medicaid
ILK27797Medicare PIN
ILK27795Medicare PIN