Healthcare Provider Details

I. General information

NPI: 1134781412
Provider Name (Legal Business Name): JOSHUA DWAINE LENTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 BROADWAY
HIGHLAND IL
62249-1960
US

IV. Provider business mailing address

6810 STATE ROUTE 162 STE 215
MARYVILLE IL
62062-8566
US

V. Phone/Fax

Practice location:
  • Phone: 618-651-0022
  • Fax: 618-651-0023
Mailing address:
  • Phone: 618-391-6495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.154803
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301505964
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036158237
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: