Provider Demographics
NPI:1841242716
Name:FOX, JACOB H (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:H
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:#1106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3824
Mailing Address - Country:US
Mailing Address - Phone:312-942-7043
Mailing Address - Fax:312-942-2380
Practice Address - Street 1:1725 W HARRISON
Practice Address - Street 2:#1106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3824
Practice Address - Country:US
Practice Address - Phone:312-942-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL031 0476622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047662Medicaid
IL336013823OtherIL DEPT OF FU PROF
AF1975753OtherDEA
IL036047662Medicaid
C43167Medicare UPIN