Joel Stuart Retholtz, D.O..

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

34-00-2442 Issued in OH

Practice address

1103 Village Square Dr
Ste 100
Perrysburg, OH 43551-1762

Phone

(419) 872-3213

Fax

(419) 872-9549

NPI assigned

May 24, 2005

Last updated

Feb 17, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424131200000",
    "number": "1396748364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 VILLAGE SQUARE DR",
            "address_2": "STE 100",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435511762",
            "telephone_number": "419-872-3213",
            "fax_number": "419-872-9549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 VILLAGE SQUARE DR",
            "address_2": "STE 100",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435511762",
            "telephone_number": "419-872-3213",
            "fax_number": "419-872-9549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETHOLTZ",
        "first_name": "JOEL",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "D.O..",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2015-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34-00-2442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0366330",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Perrysburg, OH
• Providers in Perrysburg, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.