Provider Demographics
NPI:1952560443
Name:KLAUSTERMEIER, JACOB ALLEN (PAC)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:ALLEN
Last Name:KLAUSTERMEIER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E TERRA COTTA AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3650
Mailing Address - Country:US
Mailing Address - Phone:815-455-4434
Mailing Address - Fax:815-455-7143
Practice Address - Street 1:820 E TERRA COTTA AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3649
Practice Address - Country:US
Practice Address - Phone:815-455-4434
Practice Address - Fax:815-455-4591
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002984207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology