MEDICARE: STEPHANIE MARIE 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	208600000X	Surgery Physician	036178639	IL

General Provider Information

NPI Number	:	1396321881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE JENSEN MD

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE # 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-982-3175
Fax Number	:	847-982-3394

Provider Business Practice Location Address
First Line	:	2500 RIDGE AVE # 300
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-2455
Country	:	US
Telephone Number	:	847-570-2700
Fax Number	:	847-570-2282

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

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	04/22/2026

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