Provider Demographics
NPI:1295707578
Name:HERTENSTEIN, JAMES CURTIS (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CURTIS
Last Name:HERTENSTEIN
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 1:8600 N STATE RT 91
Mailing Address - Street 2:STE 300
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-691-6616
Mailing Address - Fax:309-691-2943
Practice Address - Street 1:8600 N STATE RT 91
Practice Address - Street 2:STE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615
Practice Address - Country:US
Practice Address - Phone:309-691-6616
Practice Address - Fax:309-691-2943
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL933610Medicare ID - Type Unspecified
C84479Medicare UPIN