Healthcare Provider Details

I. General information

NPI: 1710500103
Provider Name (Legal Business Name): MAXWELL JAMES JENTSCH DO, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 06/15/2024
Certification Date: 06/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 CENTER RIDGE RD
WESTLAKE OH
44145-5219
US

IV. Provider business mailing address

29000 CENTER RIDGE RD
WESTLAKE OH
44145-5219
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.016236
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number81374-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: