Most Relevant Information
Provider Data
| NPI Number: | 1003818212 |
| Provider Name: | JOHN L JENKINS M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 174400000X |
| Specialty: | Specialist |
| License Number: | 01025732 |
Most Important Dates
| Enumeration Date: | 06/01/2005 |
| Last Updated: | 10/06/2010 |
Provider Practice Location
621 MEMORIAL DR
STE 502
SOUTH BEND
IN
466011075
Practice Location Phone/Fax
| Phone: | 5742349001 |
| Fax: | 5742875367 |
Provider Mailing Location
621 MEMORIAL DR
STE 502
SOUTH BEND
IN
466011075
Provider Mailing Phone/Fax
| Phone: | 5742349001 |
| Fax: | 5742875367 |