Provider Demographics
NPI:1801886908
Name:JACOBS, KAREN J (DO)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 HAWKSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1583
Mailing Address - Country:US
Mailing Address - Phone:765-661-2530
Mailing Address - Fax:
Practice Address - Street 1:1509 HAWKSVIEW DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1583
Practice Address - Country:US
Practice Address - Phone:765-661-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002238A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001045074OtherANTHEM
IN200283250AMedicaid
IN296260052Medicare PIN
IN2962600Medicare PIN