Provider Demographics
NPI:1174522163
Name:JACOBS, LOUIS ISRAEL (DO)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ISRAEL
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:18181 OAKWOOD BLVD 403
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3960
Mailing Address - Country:US
Mailing Address - Phone:313-982-5290
Mailing Address - Fax:313-982-5295
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:SUITE #206
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-421-0044
Practice Address - Fax:734-458-3364
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILJ006797207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1367083Medicaid
MI5821167OtherBCBSM
MI58200916141Medicare ID - Type Unspecified
MI5821167OtherBCBSM