Provider Demographics
NPI:1568885408
Name:JENKINS, MICHAEL JR (EMT, CHT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:JENKINS
Suffix:JR
Gender:M
Credentials:EMT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13430 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1638
Mailing Address - Country:US
Mailing Address - Phone:313-736-2000
Mailing Address - Fax:
Practice Address - Street 1:13430 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1638
Practice Address - Country:US
Practice Address - Phone:313-736-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver