Jacob, Michael D

Jacob, Michael D is an individual health care provider with primary practice located at 7150 Clearvista Drive , Indianapolis IN 37043. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Jacob, Michael D can be contacted via phone (317) 621-5890.

Contact Information

Primary practice address
7150 Clearvista Drive Indianapolis IN 37043
Phone: (317) 621-5890
Fax: (317) 355-2205
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 103360 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 28181433A Indiana

Profile Details

NPI number 1508824905
LBN Legal business name Jacob, Michael D
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2006
Last updated Jul 21st, 2015 - about 10 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 1508824905 NPPES
Indiana Other 000000595410 ANTHEM
Indiana MEDICAID 3628323 ANTHEM
Indiana MEDICAID 200926510 ANTHEM

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