Provider Demographics
NPI:1770757130
Name:BLOOM, JACOB MAXWELL-PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:MAXWELL-PHILLIP
Last Name:BLOOM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 E DELAWARE PL STE 501
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1666
Mailing Address - Country:US
Mailing Address - Phone:312-535-3721
Mailing Address - Fax:
Practice Address - Street 1:1 E DELAWARE PL STE 501
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1666
Practice Address - Country:US
Practice Address - Phone:312-549-8691
Practice Address - Fax:312-549-8692
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361345522082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand