Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 36-00-2994-C | OH |
NPI | 1083617559 |
---|---|
Provider Name | Dr. Joel William Consolo |
First Address | Tiffin, OH 44883-0177 |
Second Address | Tiffin, OH 44883-2241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 02/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000299376 | ANTHEM (01) | OH |
0007037229 | AETNA (01) | OH |
2240695 | (05) | OH |
U80949 | (02) | OH |