Provider Demographics
NPI:1508956707
Name:JENKINS, JONDELLE B (DPM)
Entity Type:Individual
Prefix:DR
First Name:JONDELLE
Middle Name:B
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2740
Mailing Address - Country:US
Mailing Address - Phone:773-374-5300
Mailing Address - Fax:773-374-5860
Practice Address - Street 1:1706 E 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2740
Practice Address - Country:US
Practice Address - Phone:773-374-5300
Practice Address - Fax:773-374-5860
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003520213ES0000X, 213EP1101X, 213ER0200X, 213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003520Medicaid
IL0001621735OtherBLUE CROSS BLUE SHIELD
ILP00276675OtherRAILROAD MEDICARE
ILP00276675OtherRAILROAD MEDICARE
IL016003520Medicaid
ILL98130Medicare PIN