Chris Jacob, DO in Saint Clair Shores, MI - Student in an Organized Health Care Education/Training Program

Chris Jacob, DO is a Student In An Organized Health Care Education/training Program physician based in Saint Clair Shores, Michigan. Chris Jacob is licensed to practice in Michigan (license number 5151009894) and his current practice location is 24211 Little Mack Ave, Saint Clair Shores, Michigan. He can be reached at his office (for appointments etc.) via phone at (586) 498-0440.

NPI number for Chris Jacob is 1790163962 and his current mailing address is 601 Elmwood Ave Box Med, Rochester, New York. He does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1790163962.

Contact Information

	Chris Jacob, DO
	24211 Little Mack Ave, Saint Clair Shores, MI 48080-1151
	(586) 498-0440
	(586) 498-0401

Physician's Profile

Full Name	Chris Jacob
Gender	Male
Speciality	Student In An Organized Health Care Education/training Program
Location	24211 Little Mack Ave, Saint Clair Shores, Michigan
Accepts Medicare Assignments	Does not participate in Medicare Program. He may not accept medicare assignment.

NPI Data:

NPI Number: 1790163962
Provider Enumeration Date: 05/08/2015
Last Update Date: 06/29/2021

Medical Identifiers

Medical identifiers for Chris Jacob such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1790163962	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208M00000X	Hospitalist	293779 (New York)	Secondary
390200000X	Student In An Organized Health Care Education/training Program	5101021621 (Michigan)	Secondary
207R00000X	Internal Medicine	5101021621 (Michigan)	Secondary
390200000X	Student In An Organized Health Care Education/training Program	5151009894 (Michigan)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Chris Jacob is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Chris Jacob, DO 601 Elmwood Ave Box Med, Rochester, NY 14642-0001 Ph: (585) 275-4912	Chris Jacob, DO 24211 Little Mack Ave, Saint Clair Shores, MI 48080-1151 Ph: (586) 498-0440

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Chris Jacob, DO - Student in an Organized Health Care Education/Training Program in Saint Clair Shores, MI