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1639388333

NPI Code Detail

MEDICARE: TREVOR LAWRENCE JENKINS MD

MEDICARE: TREVOR LAWRENCE 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RC0000X	Cardiovascular Disease Physician	35.093500	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BP1-0026144	OTHER		INSTITUTIONAL PERMIT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639388333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR LAWRENCE JENKINS MD

Provider Business Mailing Address
First Line	:	24701 EUCLID AVE
Second Line	:	3RD FLOOR
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVE
Second Line	:	DIVISION OF CARDIOVASCULAR MEDICINE LKS 5038
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1716
Country	:	US
Telephone Number	:	216-844-7696
Fax Number	:	216-844-8954

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	12/30/2020

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Directions to “ TREVOR LAWRENCE JENKINS MD” Practice Location

Language	Start Address	Practice Location

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