Provider Demographics
NPI:1578862033
Name:BENTLEY, JOSHUA MAXWELL (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MAXWELL
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1250 BARDSTOWN RD STE 8
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1333
Practice Address - Country:US
Practice Address - Phone:502-456-7047
Practice Address - Fax:502-457-1491
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY47083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01492227 (KOHMG)OtherRR MEDICARE
KY7100217160Medicaid
KY7100217160Medicaid