Provider Demographics
NPI:1053936617
Name:JENSEN, BODRIE J (DO)
Entity type:Individual
Prefix:
First Name:BODRIE
Middle Name:J
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E BUSINESS WAY
Mailing Address - Street 2:
Mailing Address - City:SHARONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2374
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:
Practice Address - Street 1:500 E BUSINESS WAY
Practice Address - Street 2:
Practice Address - City:SHARONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45241-2374
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program