Provider Demographics
NPI:1154314193
Name:JENSEN, STEVEN LEROY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEROY
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2558
Mailing Address - Country:US
Mailing Address - Phone:989-791-4020
Mailing Address - Fax:989-921-8765
Practice Address - Street 1:1117 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2558
Practice Address - Country:US
Practice Address - Phone:989-791-4020
Practice Address - Fax:989-921-8765
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISJ0675652088P0231X
MI4301067565208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4153090Medicaid
MI4153080Medicaid
MI5377212OtherAETNA
MIM033277OtherCHAMPUS
MI340019587OtherTRICARE
MI340013817OtherRAILROAD MEDICARE
MI3J770113OtherHEALTHPLUS
MI340G310500OtherBLUE CROSS AND BLUE SHIEL
MIF30986Medicare UPIN
MI3J770113OtherHEALTHPLUS