Provider Demographics
NPI:1942080585
Name:JAKUBOWSKI, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:JAKUBOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 N HOLLAND SYLVANIA RD APT 3308
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3551
Mailing Address - Country:US
Mailing Address - Phone:419-508-9869
Mailing Address - Fax:
Practice Address - Street 1:4430 N HOLLAND SYLVANIA RD APT 3308
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3551
Practice Address - Country:US
Practice Address - Phone:419-508-9869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0034690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily