Provider Demographics
NPI:1619242179
Name:DANIEL L JENSEN D O P L L C
Entity Type:Organization
Organization Name:DANIEL L JENSEN D O P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-772-2494
Mailing Address - Street 1:27500 HOOVER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4586
Mailing Address - Country:US
Mailing Address - Phone:586-754-2558
Mailing Address - Fax:586-754-2426
Practice Address - Street 1:27500 HOOVER RD
Practice Address - Street 2:STE 100
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4586
Practice Address - Country:US
Practice Address - Phone:586-754-2558
Practice Address - Fax:586-754-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty