MEDICARE: BLAIR JENKINS MD

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	4301511550	MI
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1124655451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAIR JENKINS MD

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1633
Country	:	US
Telephone Number	:	734-647-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 W MICHIGAN AVE
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-5443
Country	:	US
Telephone Number	:	734-936-4054
Fax Number	:	734-647-2540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	08/01/2025

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Directions to “ BLAIR JENKINS MD” Practice Location

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