Provider Demographics
NPI:1972603512
Name:JENSEN, MICHAEL LAWRENCE (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10556 COMBIE RD
Mailing Address - Street 2:#6439
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8908
Mailing Address - Country:US
Mailing Address - Phone:530-268-4664
Mailing Address - Fax:530-268-4666
Practice Address - Street 1:380 SIERRA COLLEGE DR
Practice Address - Street 2:STE 200
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5081
Practice Address - Country:US
Practice Address - Phone:530-477-0893
Practice Address - Fax:530-477-1450
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7018208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7018OtherBLUE CROSS
CA20A7018OtherBLUE SHIELD
CAP00036911OtherMEDICARE RR
CAG48762Medicare UPIN