Healthcare Provider Details

I. General information

NPI: 1902833122
Provider Name (Legal Business Name): JOEL S STOECKELER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 10TH AVE.
BALDWIN WI
54002-0300
US

IV. Provider business mailing address

730 10TH AVE.
BALDWIN WI
54002-0300
US

V. Phone/Fax

Practice location:
  • Phone: 715-684-3311
  • Fax: 715-684-4757
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31618
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: