Provider Demographics
NPI:1871114348
Name:JENKINSON, PATRICK JAMES (DO, MBA, MS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:JENKINSON
Suffix:
Gender:M
Credentials:DO, MBA, MS
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Mailing Address - Street 1:1500 E MEDICAL CENTER DR SPC 5360
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5360
Mailing Address - Country:US
Mailing Address - Phone:734-764-3269
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR SPC 5360
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5360
Practice Address - Country:US
Practice Address - Phone:734-764-3269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151014379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5151014379OtherSTATE OF MICHIGAN - DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS