Provider Demographics
NPI:1871553255
Name:JENSEN, CYNTHIA L (DO)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:L
Last Name:JENSEN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781-1048
Mailing Address - Country:US
Mailing Address - Phone:906-643-0405
Mailing Address - Fax:906-643-1553
Practice Address - Street 1:205 OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:LAURIUM
Practice Address - State:MI
Practice Address - Zip Code:49913-2134
Practice Address - Country:US
Practice Address - Phone:906-337-6560
Practice Address - Fax:906-337-6582
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD16864207RX0202X
MI5101014312207RX0202X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871553255OtherWI MEDICAID
MI1871553255Medicaid
MIP01393231OtherRAILROAD MEDICARE
H76223Medicare UPIN
MI1871553255Medicaid
FL16612YMedicare PIN