Provider Demographics
NPI:1265540827
Name:JACOB, SINDHU SONY (MD)
Entity type:Individual
Prefix:
First Name:SINDHU
Middle Name:SONY
Last Name:JACOB
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 1:1920 DON WICKHAM DR
Mailing Address - Street 2:SUITE 325
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1918
Mailing Address - Country:US
Mailing Address - Phone:352-536-8644
Mailing Address - Fax:352-536-8645
Practice Address - Street 1:1920 DON WICKHAM DR
Practice Address - Street 2:SUITE 325
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1918
Practice Address - Country:US
Practice Address - Phone:352-536-8644
Practice Address - Fax:352-536-8645
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061003A207RE0101X
FLME111323207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
4590933OtherCIGNA
IL1967884228OtherILLINOIS PUBLIC AID
IN200528700YMedicaid
351904269197OtherCARESOURCE MEDICAID
351904269198OtherCARESOURCE MEDICAID
INP00813276OtherRAILROAD MEDICARE
718423OtherHEALTHLINK
P00315176OtherRAILROAD MCARE PALAMETTO
IN200528700OtherMOLINA HEALTHCARE MCAID
IN200528700TMedicaid
3802033OtherAETNA
000000372415OtherANTHEM
IN200528700GMedicaid
IN200528700XMedicaid
351904269205OtherCARESOURCE MEDICAID
IN200528700YMedicaid
3802033OtherAETNA
351904269205OtherCARESOURCE MEDICAID
IL1967884228OtherILLINOIS PUBLIC AID
000000372415OtherANTHEM
IN265130WWWMedicare PIN