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Individual

PETER C HENTZEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD., M.D.

Contact information

Practice address
530 S JACKSON ST, # C07, LOUISVILLE, KY 40202-1675
(502) 852-5875
(502) 852-1754
Mailing address
PO BOX 21249, LOUISVILLE, KY 40221-0249
(502) 581-1500
(502) 540-4959

Taxonomy

Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
34143
KY
2085R0202X
Diagnostic Radiology Physician
Primary
34143
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000049954
ANTHEM
KY
05
64341431
KY
Enumeration date
06/13/2005
Last updated
02/19/2008
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