Provider Demographics
NPI:1427609676
Name:MECHLOWITZ, JACOB BENJAMIN (DPM)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:BENJAMIN
Last Name:MECHLOWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2182
Mailing Address - Country:US
Mailing Address - Phone:248-808-6012
Mailing Address - Fax:
Practice Address - Street 1:1695 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2182
Practice Address - Country:US
Practice Address - Phone:248-808-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003928213E00000X
MI5901400451213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist