Jensen, Jerry Lee

Jensen, Jerry Lee is an sole proprietor health care provider with primary practice located at 15525 S Park Ave Suite 113, South Holland IL 60473-1308. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jensen, Jerry Lee can be contacted via phone (708) 331-5100.

Contact Information

Primary practice address
15525 S Park Ave Suite 113 South Holland IL 60473-1308
Phone: (708) 331-5100
Fax: (708) 331-5005
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036071680 Illinois

Profile Details

NPI number 1558372615
LBN Legal business name Jensen, Jerry Lee
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 11th, 2006
Last updated Jul 25th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1558372615 NPPES
Illinois Other 0031603768 BLUE CROSS
Illinois MEDICAID 036071680 BLUE CROSS
Illinois Other 14D0913083 BLUE CROSS

Popular Providers