Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jaisy Jacob

Individual provider Body Imaging Physician · NPI 1639468614

Jaisy Jacob is a Diagnostic Radiology in Detroit, Michigan. Qualified in 2011, 15 years ago. Practices with Henry Ford Health System, a 2,540-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
15
Licensed in
MI
In the registry since
2011
Specialties on file
2

Practice location Address checks out

4100 John R St
Detroit, MI 48201-2013
Phone: (313) 576-9900
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3601 W 13 Mile Rd, Royal Oak, MI 48073 — (248) 898-6031

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 4301107800 (MI)
Body Imaging Physician Taxonomy 2085B0100X · Licence 4301107800 (MI)

Record details

NPI number1639468614
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 30, 2011
Last updated in NPPESMay 13, 2022
Certification dateMay 13, 2022
Mailing address4100 John R St, Detroit, MI 48201-2013

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Henry Ford Health System — 2540 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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