Provider Demographics
NPI:1114605748
Name:SORENSEN, JACOB H (PA-C)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:H
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3201 OLD GLENVIEW RD STE 130
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2964
Mailing Address - Country:US
Mailing Address - Phone:847-673-6505
Mailing Address - Fax:847-673-2099
Practice Address - Street 1:3201 OLD GLENVIEW RD STE 130
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2964
Practice Address - Country:US
Practice Address - Phone:847-673-6505
Practice Address - Fax:847-673-2099
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085011078363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical