Provider Demographics
NPI:1801122536
Name:CARY ANN JENKINS, MD, LLC
Entity type:Organization
Organization Name:CARY ANN JENKINS, MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-941-5160
Mailing Address - Street 1:1499 LAKEWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1791
Mailing Address - Country:US
Mailing Address - Phone:815-941-5160
Mailing Address - Fax:
Practice Address - Street 1:1499 LAKEWOOD DR
Practice Address - Street 2:UNIT A
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1709
Practice Address - Country:US
Practice Address - Phone:847-738-0542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117595207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841390572OtherINDIVIDUAL NPI
ILK45297Medicare PIN