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General NPI Number Information
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NPI Number | 1164405460
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Entity Type | Individual
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Provider Name | KENNETH HENTSCHEL DO, PHD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 4205 BELFORT RD STE 1100
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5876
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Country | US
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Telephone | 904-450-6300
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Fax | 904-281-5866
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Provider Business Mailing Address
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Address Line | 3 SHIRCLIFF WAY SUITE 724
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4786
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Country | US
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Telephone | 904-308-7959
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Fax | 904-308-7938
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number | OS8644
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 057817
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | OS8644
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | OS8644
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License Number State | FL
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