Provider Demographics
NPI:1184816506
Name:JACOBS, KATHERINE MARIE (DO)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 FRANCE AVE S STE 510
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2116
Mailing Address - Country:US
Mailing Address - Phone:952-285-3880
Mailing Address - Fax:952-479-5540
Practice Address - Street 1:6545 FRANCE AVE S STE 510
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2116
Practice Address - Country:US
Practice Address - Phone:952-285-3880
Practice Address - Fax:952-479-5540
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53913207VM0101X
TXQ0465207VM0101X
MN20167207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology