Individual
DR. JERRY LEE JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
15525 S PARK AVE, SUITE 113, SOUTH HOLLAND, IL 60473-1308
(708) 331-5100
(708) 331-5005
Mailing address
24239 E CUMBERLAND CT, CRETE, IL 60417-1854
(708) 672-8940
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036071680
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031603768
BLUE CROSS
IL
05
—
036071680
—
IL
01
—
14D0913083
CLIA NUMBER
—
Enumeration date
08/11/2006
Last updated
07/25/2023
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