Provider Demographics
NPI:1134263312
Name:JACOBS, MICHAEL B (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:401 BURGESS DR STE B
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3476
Mailing Address - Country:US
Mailing Address - Phone:650-325-9906
Mailing Address - Fax:650-325-1295
Practice Address - Street 1:401 BURGESS DR STE B
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3476
Practice Address - Country:US
Practice Address - Phone:650-325-9906
Practice Address - Fax:650-325-1295
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2011-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG17120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A39992Medicare UPIN