Basic Information
| Provider Information | |||||||||
| NPI: | 1346208824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACOBUS | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | HOHENLOHE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15100 BIRCHAVEN LN | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458409773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194235351 | ||||||||
| FaxNumber: | 4194238967 | ||||||||
| Practice Location | |||||||||
| Address1: | 15100 BIRCHAVEN LN | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458409773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194235351 | ||||||||
| FaxNumber: | 4194238967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35085523 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 4301097517 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PH0002X | 35.085523 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2637310 | 05 | OH | MEDICAID |