Individual
MARK K JENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
124 SIEGLER ST, GREEN BAY, WI 54303-2636
(920) 494-9661
(920) 496-3792
Mailing address
124 SIEGLER ST, GREEN BAY, WI 54303-2636
(920) 494-9661
(920) 496-3792
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29927
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31473000
—
WI
Enumeration date
04/03/2006
Last updated
11/05/2012
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