Active NPI
Mark D. Jakubek
- Specialist
- La Crosse, WI
National Provider Identifier
1003829649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 761-039
- Practice address
- 1725 State St
La Crosse, WI 54601-3742 - Phone
- (920) 642-0201
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 761-039 | WI | Primary |
Addresses
Primary practice location
1725 State St
La Crosse, WI 54601-3742
Mailing address
1013 State St Apt 8
La Crosse, WI 54601-3495
Phone (920) 642-0201
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 761-039 | WI | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003829649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1013 STATE ST APT 8",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546013495",
"telephone_number": "920-642-0201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1725 STATE ST",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546013742",
"telephone_number": "920-642-0201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAKUBEK",
"first_name": "MARK",
"middle_name": "D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WI",
"license": "761-039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Crosse, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.