Individual
DR. KENNETH HENTSCHEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, PHD
Contact information
Practice address
4205 BELFORT RD STE 1100, JACKSONVILLE, FL 32216-5876
(904) 450-6300
(904) 281-5866
Mailing address
3 SHIRCLIFF WAY, SUITE 724, JACKSONVILLE, FL 32204-4786
(904) 308-7959
(904) 308-7938
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
OS8644
FL
2084N0400X
Neurology Physician
057817
GA
2084N0400X
Neurology Physician
Primary
OS8644
FL
2084N0600X
Clinical Neurophysiology Physician
OS8644
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212536998A
—
GA
05
—
212536998B
—
GA
05
—
2757087-00
—
FL
05
—
275708700
—
FL
Enumeration date
11/22/2005
Last updated
07/29/2019
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