Provider Demographics
NPI:1720132319
Name:HENNUM, JESSE LENHARDT (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:LENHARDT
Last Name:HENNUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 E 28TH ST
Mailing Address - Street 2:MR 11326
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3723
Mailing Address - Country:US
Mailing Address - Phone:612-863-7560
Mailing Address - Fax:612-863-3809
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:MR 11326
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-7560
Practice Address - Fax:612-863-3809
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN49149207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine