Basic Information
| Provider Information | |||||||||
| NPI: | 1841230950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAMMEYER | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | AARON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3355 GLENDALE AVE | ||||||||
| Address2: | FL 3 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193835334 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2222 CHERRY ST. | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192514787 | ||||||||
| FaxNumber: | 4192517817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-087375 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2006-01021 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35087375 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 35087375 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 0055374 | 05 | OH | MEDICAID | 2622835 | 05 | OH | MEDICAID |