MEDICARE: STEVEN LEROY JENSEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2088P0231X	Pediatric Urology Physician	SJ067565	MI
2	208800000X	Urology Physician	4301067565	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	340013817	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5377212	OTHER	MI	AETNA
4	M033277	OTHER	MI	CHAMPUS
5	340019587	OTHER	MI	TRICARE
7	3J770113	OTHER	MI	HEALTHPLUS
8	340G310500	OTHER	MI	BLUE CROSS AND BLUE SHIEL

General Provider Information

NPI Number	:	1154314193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN LEROY JENSEN MD

Provider Business Mailing Address
First Line	:	1117 S WASHINGTON AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-2558
Country	:	US
Telephone Number	:	989-791-4020
Fax Number	:	989-921-8765

Provider Business Practice Location Address
First Line	:	1117 S WASHINGTON AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-2558
Country	:	US
Telephone Number	:	989-791-4020
Fax Number	:	989-921-8765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	09/20/2023

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Directions to “ STEVEN LEROY JENSEN MD” Practice Location

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