Provider Demographics
NPI:1275205387
Name:IBELING, JOEL ROBERT (AEMT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ROBERT
Last Name:IBELING
Suffix:
Gender:M
Credentials:AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 ORIOLE LN
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523-9297
Mailing Address - Country:US
Mailing Address - Phone:608-512-5473
Mailing Address - Fax:
Practice Address - Street 1:3250 KINGSLEY WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4628
Practice Address - Country:US
Practice Address - Phone:608-354-9239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI300168146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate