Provider Demographics
NPI:1902885841
Name:JACOBS, JOSHUA J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:J
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WESTBROOK CORPORATE CTR
Mailing Address - Street 2:SUITE #240
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:STE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-243-4244
Practice Address - Fax:312-942-1517
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074410207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDA4902OtherRR MEDICARE PTAN#
IL207073OtherMEDICARE LOCALITY #15
ILP00094334OtherRR MEDICARE ID#
IL207067OtherMEDICARE LOCALITY #16
IL4122842OtherAETNA ID#
IL036074410 4Medicaid
IL1633878OtherBCBS GROUP ID#
ILK01197Medicare PIN
IL207073OtherMEDICARE LOCALITY #15
ILP00094334OtherRR MEDICARE ID#