Provider Demographics
NPI:1689105413
Name:JACOB-CHARLY, EUNICE SAJAN (DO)
Entity type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:SAJAN
Last Name:JACOB-CHARLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:EUNICE
Other - Middle Name:SAJAN
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2250 POINT BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7869
Mailing Address - Country:US
Mailing Address - Phone:224-212-0205
Mailing Address - Fax:224-253-4973
Practice Address - Street 1:2250 POINT BLVD STE 140
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7869
Practice Address - Country:US
Practice Address - Phone:224-212-0205
Practice Address - Fax:224-253-4973
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.151197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine