Provider Demographics
NPI:1982851432
Name:JACOBS-PUPINO, LYNNETTE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:MARIE
Last Name:JACOBS-PUPINO
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 1:3030 W SALT CREEK LANE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1069
Mailing Address - Country:US
Mailing Address - Phone:847-827-3008
Mailing Address - Fax:847-483-7447
Practice Address - Street 1:800 W BIESTERFIELD RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3378
Practice Address - Country:US
Practice Address - Phone:847-981-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine