MEDICARE: CARY ANN JENKINS, MD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	036117595	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1841390572	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1801122536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARY ANN JENKINS, MD, LLC

Provider Business Mailing Address
First Line	:	1499 LAKEWOOD DR STE A
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-1791
Country	:	US
Telephone Number	:	815-941-5160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1499 LAKEWOOD DR
Second Line	:	UNIT A
City	:	MORRIS
State	:	IL
Zip	:	60450-1709
Country	:	US
Telephone Number	:	847-738-0542
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	CARY JENKINS
Credential	:	MD
Telephone Number	:	815-941-5160

Provider Enumeration Date	:	10/30/2009
Last Update Date	:	03/21/2025

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