Provider Demographics
NPI:1063917243
Name:JENSON, MATTHEW KRUEGER (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KRUEGER
Last Name:JENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 SIEGLER ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2636
Mailing Address - Country:US
Mailing Address - Phone:920-494-9661
Mailing Address - Fax:920-496-3792
Practice Address - Street 1:124 SIEGLER ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2636
Practice Address - Country:US
Practice Address - Phone:920-494-9661
Practice Address - Fax:920-496-3792
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine