Individual
KENNETH F. JENSEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1777 W GRAND AVE, PORT WASHINGTON, WI 53074-2077
(262) 284-3456
(262) 284-4543
Mailing address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21735
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30317300
—
WI
01
—
P00449578
RR MEDICARE
WI
Enumeration date
07/11/2006
Last updated
12/23/2010
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