MEDICARE: DR. JOEL WILLIAM CONSOLO D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	36-00-2994-C	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0007037229	OTHER	OH	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000299376	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1083617559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL WILLIAM CONSOLO D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 177
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-0177
Country	:	US
Telephone Number	:	419-443-8637
Fax Number	:	419-443-9937

Provider Business Practice Location Address
First Line	:	40 CLAY ST
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-2241
Country	:	US
Telephone Number	:	419-443-8637
Fax Number	:	419-443-9937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/02/2007

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