Provider Demographics
NPI:1649573361
Name:RONALD L JENSON MD PC
Entity Type:Organization
Organization Name:RONALD L JENSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:JENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-799-8420
Mailing Address - Street 1:2233 N CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3730
Mailing Address - Country:US
Mailing Address - Phone:989-799-8420
Mailing Address - Fax:989-799-2251
Practice Address - Street 1:2233 N CENTER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3730
Practice Address - Country:US
Practice Address - Phone:989-799-8420
Practice Address - Fax:989-799-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1043998Medicaid
MIB44600Medicare UPIN