Provider Demographics
NPI:1851391726
Name:JENIKE, JOSEPH S (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:JENIKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 PERSIMMON PL
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-5794
Mailing Address - Country:US
Mailing Address - Phone:972-412-0169
Mailing Address - Fax:972-412-0169
Practice Address - Street 1:3005 PERSIMMON PL
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5794
Practice Address - Country:US
Practice Address - Phone:972-412-0169
Practice Address - Fax:972-412-0169
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD22452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B1692Medicare ID - Type Unspecified
C17425Medicare UPIN