Most Relevant Information
Provider Data
| NPI Number: | 1003829649 |
| Provider Name: | MARK D. JAKUBEK |
| Entity Type: | Individual |
| Taxonomy Code: | 174400000X |
| Specialty: | Specialist |
| License Number: | 761-039 |
Most Important Dates
| Enumeration Date: | 08/14/2006 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
1725 STATE ST
LA CROSSE
WI
546013742
Practice Location Phone/Fax
| Phone: | 9206420201 |
| Fax: |
Provider Mailing Location
1013 STATE ST APT 8
LA CROSSE
WI
546013495
Provider Mailing Phone/Fax
| Phone: | 9206420201 |
| Fax: |