Provider Demographics
NPI:1912981796
Name:JACOBSON, DONALD M (MD)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:M
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3701 DURAND AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4458
Mailing Address - Country:US
Mailing Address - Phone:262-598-9030
Mailing Address - Fax:262-598-9032
Practice Address - Street 1:3701 DURAND AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4458
Practice Address - Country:US
Practice Address - Phone:262-598-9030
Practice Address - Fax:262-598-9032
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI337292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A74083Medicare UPIN