Pothen Jacob, MD - Pediatrics in E St Louis, IL

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Pothen Jacob, MD is a Pediatrics physician based in E St Louis, Illinois. Pothen Jacob is licensed to practice in Illinois (license number 3648725) and his current practice location is 4601 State St, Suite #210, E St Louis, Illinois. He can be reached at his office (for appointments etc.) via phone at (618) 874-3700.

NPI number for Pothen Jacob is 1376640474 and his current mailing address is Po Box 2228, 4601 State St Suite #210, E St Louis, Illinois. He does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1376640474.

Contact Information

Pothen Jacob, MD
4601 State St, Suite #210,
E St Louis, IL 62205-1359
(618) 874-3700
(618) 874-5031

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Physician's Profile

Full NamePothen Jacob
GenderMale
SpecialityPediatrics
Location4601 State St, E St Louis, Illinois
Accepts Medicare AssignmentsDoes not participate in Medicare Program. He may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1376640474
  • Provider Enumeration Date: 09/20/2006
  • Last Update Date: 07/08/2007

Medical Identifiers

Medical identifiers for Pothen Jacob such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1376640474NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
208000000XPediatrics 3648725 (Illinois)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Pothen Jacob is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Pothen Jacob, MD
Po Box 2228, 4601 State St Suite #210,
E St Louis, IL 62205-1359

Ph: (618) 874-3700		Pothen Jacob, MD
4601 State St, Suite #210,
E St Louis, IL 62205-1359

Ph: (618) 874-3700

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Pediatrics Doctors in E St Louis, IL


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