Healthcare Provider Details

I. General information

NPI: 1376359521
Provider Name (Legal Business Name): MEDSENSE HEALTH PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 TOWNE CENTRE BLVD STE 250
ANNAPOLIS MD
21401-3599
US

IV. Provider business mailing address

PO BOX 96421
PHOENIX AZ
85072-6421
US

V. Phone/Fax

Practice location:
  • Phone: 414-617-9941
  • Fax:
Mailing address:
  • Phone: 253-242-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN KLEINHANS
Title or Position: DIRECTOR
Credential:
Phone: 253-242-2705