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General NPI Number Information
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NPI Number | 1396748364
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Entity Type | Individual
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Provider Name | JOEL STUART RETHOLTZ D.O..
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 1103 VILLAGE SQUARE DR STE 100
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City | PERRYSBURG
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State | OH
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Zip | 43551-1762
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Country | US
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Telephone | 419-872-3213
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Fax | 419-872-9549
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Provider Business Mailing Address
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Address Line | 1103 VILLAGE SQUARE DR STE 100
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City | PERRYSBURG
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State | OH
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Zip | 43551-1762
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Country | US
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Telephone | 419-872-3213
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Fax | 419-872-9549
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34-00-2442
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License Number State | OH
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