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NPI Code Detail

MEDICARE: DR. JONDELLE B. JENKINS DPM

MEDICARE: DR. JONDELLE B. JENKINS DPM
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
1213ES0000XSports Medicine Podiatrist016003520IL
2213EP1101XPrimary Podiatric Medicine Podiatrist016003520IL
3213ER0200XRadiology Podiatrist016003520IL
4213ES0103XFoot & Ankle Surgery Podiatrist016003520IL
5213E00000XPodiatrist016003520IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00276675OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20001621735OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1508956707
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONDELLE B. JENKINS DPM
Provider Business Mailing Address
First Line : 1706 E 87TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-2740
Country : US
Telephone Number : 773-374-5300
Fax Number : 773-374-5860
Provider Business Practice Location Address
First Line : 1706 E 87TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-2740
Country : US
Telephone Number : 773-374-5300
Fax Number : 773-374-5860
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 10/03/2022

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1720322480 — MS. VELINDA DENISE ALEXANDER
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1706 E 87TH ST
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1003363540 — DARLA THOMAS
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1706 E 87TH ST
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