MARK KEVIN JACOB MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****56

License Status

ACTIVE

Business

Title

First Name

MARK

Middle

KEVIN

Last Name

JACOB

Business Name

MARK KEVIN JACOB MD

Original Issue Date

01/25/2023

Effective Date

05/20/2023

Expiration Date

07/31/2026

City

EAST LANSING

State

Zip

48823

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/20/2023