Basic Information
| Provider Information | |||||||||
| NPI: | 1588865091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENTZELMAN | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 S SPRING AVE # 3300 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631102520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149778884 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1225 S GRAND BLVD DEPT OF | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631041016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149775110 | ||||||||
| FaxNumber: | 3149777686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YS0012X | 2010029569 | MO | N | Allopathic & Osteopathic Physicians | Otolaryngology | Sleep Medicine | 207YS0123X | 2010029569 | MO | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YX0901X | 2010029569 | MO | N | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology | 207Y00000X | 2010029569 | MO | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.