MEDICARE: DR. ANDREW MICHAEL JEN M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207X00000X	Orthopaedic Surgery Physician	T0248	TX

General Provider Information

NPI Number	:	1548647829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW MICHAEL JEN M.D.

Provider Business Mailing Address
First Line	:	5700 E INTERSTATE 20 SERVICE RD S
Second Line	:
City	:	WILLOW PARK
State	:	TX
Zip	:	76008-5115
Country	:	US
Telephone Number	:	877-614-8990
Fax Number	:	833-794-3342

Provider Business Practice Location Address
First Line	:	5700 E INTERSTATE 20 SERVICE RD S
Second Line	:
City	:	WILLOW PARK
State	:	TX
Zip	:	76008-5115
Country	:	US
Telephone Number	:	877-614-8990
Fax Number	:

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

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	09/15/2021

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