Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 59156 | MN |
NPI | 1427290055 |
---|---|
Provider Name | Dr. Luke A Jakubowski |
First Address | Minneapolis, MN 55404 |
Second Address | Milwaukee, WI 53219-3182 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2009 |
Last Update Date | 13/08/2015 |