MEDICARE: DR. CARY ANN 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	036.117595	IL

General Provider Information

NPI Number	:	1841390572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARY ANN JENKINS MD

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	:	815-941-5165

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	:	815-941-5160
Fax Number	:

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

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	03/21/2025

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