Provider Demographics
NPI:1083617559
Name:CONSOLO, JOEL WILLIAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:WILLIAM
Last Name:CONSOLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-0177
Mailing Address - Country:US
Mailing Address - Phone:419-443-8637
Mailing Address - Fax:419-443-9937
Practice Address - Street 1:40 CLAY ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2241
Practice Address - Country:US
Practice Address - Phone:419-443-8637
Practice Address - Fax:419-443-9937
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2994-C213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0007037229OtherAETNA
OH2240695Medicaid
OH000000299376OtherANTHEM
OHCO4027583Medicare PIN
OH000000299376OtherANTHEM