Provider Demographics
NPI:1821023375
Name:JACOBS, NORMAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:MICHAEL
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:750 N DEARBORN ST
Mailing Address - Street 2:SUITE 3207
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3854
Mailing Address - Country:US
Mailing Address - Phone:312-787-0118
Mailing Address - Fax:
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:ROOM 4806
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-4267
Practice Address - Fax:312-864-9022
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-048535208000000X
IL036-485352080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G74191Medicare UPIN