Provider Demographics
NPI:1700848462
Name:JENKIN, RENATA M (MD)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:M
Last Name:JENKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SKOKIE BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7930
Mailing Address - Country:US
Mailing Address - Phone:847-272-4433
Mailing Address - Fax:847-272-4434
Practice Address - Street 1:400 SKOKIE BLVD STE 475
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7930
Practice Address - Country:US
Practice Address - Phone:847-272-4433
Practice Address - Fax:847-272-4434
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036148052207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0296575OtherL&I
WA1700848462Medicaid
WA0296575OtherL&I
H05385Medicare UPIN