Basic Information
Provider Information
NPI: 1285736736
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JENKINS
FirstName: NATASHA
MiddleName: TAMIKA
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5841 S MARYLAND AVE
Address2: MC 2050
City: CHICAGO
State: IL
PostalCode: 606371447
CountryCode: US
TelephoneNumber: 7737026127
FaxNumber: 7737020840
Practice Location
Address1: 5841 S MARYLAND AVE
Address2: MC 2050
City: CHICAGO
State: IL
PostalCode: 606371447
CountryCode: US
TelephoneNumber: 7737029200
FaxNumber: 7737020840
Other Information
ProviderEnumerationDate: 09/04/2006
LastUpdateDate: 03/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X036-115707ILY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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