Provider Demographics
NPI:1366534273
Name:JENSEN, JONATHAN B (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:B
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2450 RIVERSIDE AVE S
Mailing Address - Street 2:2 WEST
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-273-8700
Mailing Address - Fax:612-273-8787
Practice Address - Street 1:2450 RIVERSIDE AVE SE
Practice Address - Street 2:2A WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:612-273-8787
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2018-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN207992084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP22358OtherHEALTH PARTNERS
MN1009157OtherPREFERRED ONE
MN095293100Medicaid
MN102784OtherU CARE
MN1514059OtherMEDICA-CHOICE
MN260026114OtherRR MEDICARE
768179OtherARAZ
MN8D926JEOtherBLUE CROSS BLUE SHIELD
MN082701OtherFAIRVIEW
MN1514059OtherMEDICA-PRIMARY
MNHP22358OtherHEALTH PARTNERS
MN260026114OtherRR MEDICARE