Jacob, Carolyn

Jacob, Carolyn is an individual health care provider with primary practice located at 515 N State St Ste 900 , Chicago IL 60654. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Procedural Dermatology, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / Dermatology is her primary health care specialty. Jacob, Carolyn can be contacted via phone (312) 245-9965.

Contact Information

Primary practice address
515 N State St Ste 900 Chicago IL 60654
Phone: (312) 245-9965
Fax: (312) 245-9964
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Procedural Dermatology 207NS0135X 036102098 Illinois
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 036102098 Illinois

Profile Details

NPI number 1265498083
LBN Legal business name Jacob, Carolyn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 21st, 2006
Last updated Feb 5th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265498083 NPPES
Illinois MEDICAID 036102098

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