Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 35.128965 | OH |
NPI | 1295051407 |
---|---|
Provider Name | Dr. Joel David Kolmodin |
First Address | Cleveland Heights, OH 44118-2418 |
Second Address | Duluth, MN 55805-1951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2010 |
Last Update Date | 17/03/2018 |