Provider Demographics
NPI:1831162114
Name:JENTZ, IRENE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:ANN
Last Name:JENTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 MEDICAL VILLAGE DR
Mailing Address - Street 2:STE 102
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5401
Mailing Address - Country:US
Mailing Address - Phone:859-341-1011
Mailing Address - Fax:859-341-7198
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:STE 102
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5401
Practice Address - Country:US
Practice Address - Phone:859-341-1011
Practice Address - Fax:859-341-7198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29192208000000X
OH35064998208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64291925Medicaid
0637200OtherAETNA
000000033747OtherANTHEM
1220592OtherUNITED HEALTH CARE OF OH
1220592OtherUNITED HEALTH CARE OF OH