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General NPI Number Information
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NPI Number | 1083617559
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Entity Type | Individual
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Provider Name | JOEL WILLIAM CONSOLO D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 40 CLAY ST
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City | TIFFIN
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State | OH
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Zip | 44883-2241
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Country | US
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Telephone | 419-443-8637
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Fax | 419-443-9937
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Provider Business Mailing Address
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Address Line | PO BOX 177
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City | TIFFIN
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State | OH
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Zip | 44883-0177
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Country | US
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Telephone | 419-443-8637
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Fax | 419-443-9937
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36-00-2994-C
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License Number State | OH
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