Provider Demographics
NPI:1396805263
Name:JENKINS, ISABELLA B (MD)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:B
Last Name:JENKINS
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 1:8303 PLATT RD
Mailing Address - Street 2:CENTER FOR FORENSIC PSYCHIATRY
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9773
Mailing Address - Country:US
Mailing Address - Phone:734-295-4315
Mailing Address - Fax:
Practice Address - Street 1:8303 PLATT RD
Practice Address - Street 2:CENTER FOR FORENSIC PSYCHIATRY
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9773
Practice Address - Country:US
Practice Address - Phone:734-295-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010637722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI464682410Medicaid
MI5308877Medicaid
700H262290OtherBLUE CROSS-BLUE CROSS
IJ063772OtherCHAMPUS-CHAMPUS
IJ063772OtherCOMMERCIAL-COMMERCIAL NUMBER
MI5308877Medicaid
700H262290OtherBLUE CROSS-BLUE CROSS