Provider Demographics
NPI:1134172976
Name:JENSEN, STEVEN R (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
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 1:1221 NICOLLET AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2420
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1221 NICOLLET AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2420
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI263902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI300126978OtherRAILROAD MEDICARE WI
MNHP13604OtherHEALTHPARTNERS
MN300126977OtherRAILROAD MEDICARE MN
MN53G39JEOtherBLUE CROSS BLUE SHIELD OF MINNESOTA
WI30622100Medicaid
MN398280700Medicaid
MN1134172976OtherAMERICA'S PPO
MN1134172976OtherMEDICA
IA1134172976Medicaid
MN1134172976OtherMEDICA
MN300126977OtherRAILROAD MEDICARE MN
WI001456135Medicare PIN
MN300004184Medicare PIN
MN300004183Medicare PIN
A96571Medicare UPIN