Jensen, Mark A

Jensen, Mark A is an individual health care provider with primary practice located at 2217 Dubois Dr , Warsaw IN 46580-3212. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Jensen, Mark A can be contacted via phone (574) 267-8940.

Contact Information

Primary practice address
2217 Dubois Dr Warsaw IN 46580-3212
Phone: (574) 267-8940
Fax: (574) 267-5782
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 01033577 Indiana
Allopathic & Osteopathic Physicians / Surgery 208600000X 01033577 Indiana

Profile Details

NPI number 1093715062
LBN Legal business name Jensen, Mark A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 29th, 2005
Last updated Aug 28th, 2009 - about 16 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093715062 NPPES
Indiana MEDICAID 100157230A

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