NPI 1659486751

Mark B Jacob

Practitioner Oral & Maxillofacial Surgery (D.M.D.) Highland Park, IL

Practice location

Address: 1893 Sheridan Rd STE 311, Highland Park, IL 60035-2646
Phone: (847) 433-6636
Fax: (847) 433-2090
Mailing address: 809 S Marshfield Ave 9th Floor (m/C 732), Chicago, IL 60612-4305

Registered specialties

Oral & Maxillofacial Surgery (D.M.D.) Primary

Allopathic & Osteopathic Physicians Taxonomy 204E00000X Licence 021.002059 (IL)

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Registry record

NPI: 1659486751
Entity type: Individual
Sex (as registered): Male
NPI issued: 20 Aug 2006
Record last updated: 28 Dec 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.