Basic Information
| Provider Information | |||||||||
| NPI: | 1326301136 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SROUBEK | ||||||||
| FirstName: | JAKUB | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | BETH ISRAEL DEACONESS MEDICAL CENTER | ||||||||
| Address2: | 330 BROOKLINE AVENUE | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176678800 | ||||||||
| FaxNumber: | 6176327620 | ||||||||
| Practice Location | |||||||||
| Address1: | MASSACHUSETTS GENERAL HOSPITAL | ||||||||
| Address2: | 55 FRUIT ST. | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177262865 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 12/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L-251544 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.