Provider Demographics
NPI:1225011885
Name:WENTZELL, THOMAS H (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:WENTZELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 W COLONIAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3300
Mailing Address - Country:US
Mailing Address - Phone:407-877-6500
Mailing Address - Fax:321-203-4612
Practice Address - Street 1:11140 W COLONIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3300
Practice Address - Country:US
Practice Address - Phone:407-877-6500
Practice Address - Fax:321-203-4612
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2221375OtherAETNA HMO
FL47789ZOtherBCBS OF FLORIDA
FL4071768OtherAETNA PPO
FL47789ZMedicare PIN
FL4071768OtherAETNA PPO
FL47789ZOtherBCBS OF FLORIDA