Provider Demographics
NPI:1063395721
Name:OLEKSZYK, JACOB THOMAS
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:THOMAS
Last Name:OLEKSZYK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13320 SIOUX TRL
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8862
Mailing Address - Country:US
Mailing Address - Phone:248-826-4792
Mailing Address - Fax:
Practice Address - Street 1:620 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47809-1910
Practice Address - Country:US
Practice Address - Phone:812-237-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program