W Jacobsen DPM Professional Corporation

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

016004485 Issued in IL

Legal business name

W JACOBSEN DPM PROFESSIONAL CORPORATION

Practice address

1126 W Bryn Mawr Ave
Chicago, IL 60660-4410

Phone

(773) 561-7626

Fax

(773) 561-1111

NPI assigned

Apr 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Walter Joseph Jacobsen, DPM

Title

President

Phone

(773) 561-7626

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289260800000",
    "number": "1801060561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1126 W BRYN MAWR AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606604410",
            "telephone_number": "773-561-7626",
            "fax_number": "773-561-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 W BRYN MAWR AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606604410",
            "telephone_number": "773-561-7626",
            "fax_number": "773-561-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W JACOBSEN DPM PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2010-11-09",
        "status": "A",
        "authorized_official_last_name": "JACOBSEN",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-561-7626",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016004485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• W.J.Slodowy M.D.Inc.
• Samira E Waanders-Panwala, PT
• Angela Jae Waanders, M.D., MPH
• Joseph Wabomnor, PA-C
• Joseph Chuka Wabomnor, DC

• Foot & Ankle Surgery Podiatrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Foot & Ankle Surgery Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.