Provider Demographics
NPI:1386101889
Name:ROSENFELDT, JAKE
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:ROSENFELDT
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 1:3435 ANTOINE PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1099
Mailing Address - Country:US
Mailing Address - Phone:630-945-8856
Mailing Address - Fax:
Practice Address - Street 1:3435 ANTOINE PL
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1099
Practice Address - Country:US
Practice Address - Phone:630-945-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program