Provider Demographics
NPI:1962424309
Name:JACOB, HARRY SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:SAMUEL
Last Name:JACOB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE STREET SE, MMC 480
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-624-0123
Mailing Address - Fax:612-624-0123
Practice Address - Street 1:424 HARVARD STREET SE, FIRST FLOOR, SUITE M100
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA94067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04-75091OtherMEDICA PRIMARY
MNHP22077OtherHEALTHPARTNERS
MN604593OtherARAZ
MN101279OtherUCARE
MN1009156OtherPREFERRED ONE
MN30-00036OtherMEDICA CHOICE
MNA94067Medicare UPIN