Provider Demographics
NPI:1003310160
Name:JENSEN, WILL C (MD)
Entity type:Individual
Prefix:
First Name:WILL
Middle Name:C
Last Name:JENSEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER
Mailing Address - Street 2:395 WEST 12TH AVENUE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:614-293-3989
Mailing Address - Fax:614-293-9789
Practice Address - Street 1:THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER
Practice Address - Street 2:395 WEST 12TH AVENUE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-3989
Practice Address - Fax:614-293-9789
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01093364A207RP1001X, 207R00000X, 207RC0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300092138Medicaid
IN1104175832OtherANTHEM PTAN