Provider Demographics
NPI:1598723330
Name:LENSMEYER, JON PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:PETER
Last Name:LENSMEYER
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 1:1206 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3555
Mailing Address - Country:US
Mailing Address - Phone:810-984-3100
Mailing Address - Fax:810-984-1656
Practice Address - Street 1:1206 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3555
Practice Address - Country:US
Practice Address - Phone:810-984-3100
Practice Address - Fax:810-984-1656
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077044207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104271825Medicaid
MIN32180002Medicare PIN
MIG53083Medicare UPIN