Healthcare Provider Details

I. General information

NPI: 1245024702
Provider Name (Legal Business Name): MARKEA JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25865 W 12 MILE RD
SOUTHFIELD MI
48034-1817
US

IV. Provider business mailing address

2329 W GRAND BLVD
DETROIT MI
48208-1205
US

V. Phone/Fax

Practice location:
  • Phone: 313-657-4610
  • Fax: 313-818-0341
Mailing address:
  • Phone: 313-657-4610
  • Fax: 313-818-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: