Healthcare Provider Details

I. General information

NPI: 1851084198
Provider Name (Legal Business Name): JOSHUA KAUFMANN JANTZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 UNION ST STE 12
BANGOR ME
04401-3054
US

IV. Provider business mailing address

43 WHITING HILL RD STE 250
BREWER ME
04412-1018
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-7979
  • Fax: 207-947-9579
Mailing address:
  • Phone: 207-973-5000
  • Fax: 207-973-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD30511
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: