Provider Demographics
NPI:1144364993
Name:MICHAEL J. JACOBS, M. D. P.C.
Entity type:Organization
Organization Name:MICHAEL J. JACOBS, M. D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-662-4333
Mailing Address - Street 1:26850 PROVIDENCE PKWY STE 502
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1267
Mailing Address - Country:US
Mailing Address - Phone:246-662-4333
Mailing Address - Fax:
Practice Address - Street 1:26850 PROVIDENCE PKWY STE 504
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1267
Practice Address - Country:US
Practice Address - Phone:248-662-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMJ068638208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104569968Medicaid
MIH63445Medicare UPIN