Provider Demographics
NPI:1700809704
Name:JENSON, KIMBERLY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:JENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 AUDUBON WAY
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3811
Mailing Address - Country:US
Mailing Address - Phone:847-876-2200
Mailing Address - Fax:847-876-2265
Practice Address - Street 1:800 AUDUBON WAY
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3811
Practice Address - Country:US
Practice Address - Phone:847-876-2200
Practice Address - Fax:847-876-2065
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1982624763-4932996OtherBLUE CROSS BLUE SHIELD
IL04-91078OtherEVERCARE
K06428Medicare UPIN
IL04-91078OtherEVERCARE
ILI05827Medicare UPIN