Provider Demographics
NPI:1023351608
Name:EITEL, JACOB (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:EITEL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 N CAPITOL AVE
Mailing Address - Street 2:METHODIST MEDICAL TOWER, STE 640
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1261
Mailing Address - Country:US
Mailing Address - Phone:317-962-8881
Mailing Address - Fax:317-962-0838
Practice Address - Street 1:1633 N CAPITOL AVE
Practice Address - Street 2:METHODIST MEDICAL TOWER, STE 640
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1261
Practice Address - Country:US
Practice Address - Phone:317-962-8881
Practice Address - Fax:317-962-0838
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074479A2085R0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program