Ambili Mariam Jacob, is a
Student In An Organized Health Care Education/training Program based in Chicago, Illinois. Ambili Mariam Jacob is licensed to practice in * (Not Available) (license number ) and her current practice location is
836 W Wellington Ave, Chicago, Illinois. She can be reached at her office (for appointments etc.) via phone at
(773) 296-5474.
NPI number for Ambili Mariam Jacob is 1275369126 and her current mailing address is 836 W Wellington Ave, Chicago, Illinois. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1275369126.
Provider's Profile
Full Name | Ambili Mariam Jacob |
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Gender | Female |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 836 W Wellington Ave, Chicago, Illinois |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1275369126
- Provider Enumeration Date: 09/09/2024
- Last Update Date: 09/09/2024
Medical Identifiers
Medical identifiers for Ambili Mariam Jacob such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1275369126 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
163W00000X | Registered Nurse | 041410871 (Illinois) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | 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. Ambili Mariam 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 Address | Practice Location Address |
Ambili Mariam Jacob, 836 W Wellington Ave, Chicago, IL 60657-5147 Ph: (773) 296-5474 | Ambili Mariam Jacob, 836 W Wellington Ave, Chicago, IL 60657-5147 Ph: (773) 296-5474 |
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