Provider Demographics
NPI:1790846525
Name:JACOBS, RENEE H (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:H
Last Name:JACOBS
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 1:1000 REMINGTON BLVD
Mailing Address - Street 2:200
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5114
Mailing Address - Country:US
Mailing Address - Phone:630-856-6840
Mailing Address - Fax:
Practice Address - Street 1:1 SALT CREEK LN
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2936
Practice Address - Country:US
Practice Address - Phone:630-286-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063161207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063161Medicaid
L72168Medicare ID - Type Unspecified