Provider Demographics
NPI:1134157597
Name:JACOBS, MICHAEL KEITH (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KEITH
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1010 AIRPARK CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-5200
Mailing Address - Country:US
Mailing Address - Phone:615-221-4400
Mailing Address - Fax:
Practice Address - Street 1:3918 MONTCLAIR RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35213-2425
Practice Address - Country:US
Practice Address - Phone:205-705-3550
Practice Address - Fax:205-705-3554
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME100342207ND0900X
LAMD.201843207ND0900X
NC2008-00217207ND0900X
VA0101245015207ND0900X
AL25031207ND0900X
CODR0050087207ND0900X
MS21330207ND0900X
NJ25MA08863300207ND0900X
TXN2577207ND0900X
ARE6005207ND0900X
SCMD31313207ND0900X
CAA110841207ND0900X
TN42796207ND0900X
GA060107207ND0900X
NY2588121207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51136288OtherBLUE CROSS
102I221525Medicare PIN