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NPI Code Detail

MEDICARE: MARY ANNA JANSEN M.D.

MEDICARE: MARY ANNA JANSEN 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
1207Q00000XFamily Medicine Physician01073032AIN
2207Q00000XFamily Medicine PhysicianR2501KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972890481
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ANNA JANSEN M.D.
Provider Business Mailing Address
First Line : PO BOX 635283
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-5283
Country : US
Telephone Number : 812-926-3133
Fax Number : 812-926-1668
Provider Business Practice Location Address
First Line : 112 LINKS WAY
Second Line :
City : AURORA
State : IN
Zip : 47001-1403
Country : US
Telephone Number : 812-926-3133
Fax Number : 812-926-1668
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2011
Last Update Date : 11/21/2025

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Directions to “ MARY ANNA JANSEN M.D.” Practice Location

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