Individual
JACOB JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4201 SAINT ANTOINE ST, DETROIT, MI 48201-2153
(910) 922-1765
Mailing address
1946 N MOHAWK ST, APT. 1, CHICAGO, IL 60614-5220
(910) 922-1765
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A149863
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2014
Last updated
08/18/2017
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