Healthcare Provider Details

I. General information

NPI: 1154314193
Provider Name (Legal Business Name): STEVEN LEROY JENSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 S WASHINGTON AVE
SAGINAW MI
48601-2558
US

IV. Provider business mailing address

1117 S WASHINGTON AVE
SAGINAW MI
48601-2558
US

V. Phone/Fax

Practice location:
  • Phone: 989-791-4020
  • Fax: 989-921-8765
Mailing address:
  • Phone: 989-791-4020
  • Fax: 989-921-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberSJ067565
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301067565
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: