Provider Demographics
NPI:1699038034
Name:CONSOLO, MICHAEL JOEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOEL
Last Name:CONSOLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:210 W BONITA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1866
Mailing Address - Country:US
Mailing Address - Phone:909-623-3428
Mailing Address - Fax:
Practice Address - Street 1:210 W BONITA AVE STE 100
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1866
Practice Address - Country:US
Practice Address - Phone:909-623-3428
Practice Address - Fax:909-622-1923
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A15277208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology