Provider Demographics
NPI:1447330709
Name:JACOB, SAPNA (MD)
Entity type:Individual
Prefix:DR
First Name:SAPNA
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAPNA
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:131 E PARK AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2800
Mailing Address - Country:US
Mailing Address - Phone:847-327-1434
Mailing Address - Fax:847-573-8570
Practice Address - Street 1:131 E PARK AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2800
Practice Address - Country:US
Practice Address - Phone:847-327-1434
Practice Address - Fax:847-573-8570
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1096207Q00000X
IL036125939207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H39330Medicare UPIN