Provider Demographics
NPI:1548252901
Name:YEASTING, JOEL (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:YEASTING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21850 LEMOYNE RD
Mailing Address - Street 2:
Mailing Address - City:LUCKEY
Mailing Address - State:OH
Mailing Address - Zip Code:43443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30000 E RIVER RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3429
Practice Address - Country:US
Practice Address - Phone:419-661-4001
Practice Address - Fax:419-661-4015
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069408207P00000X, 2083P0500X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000322654OtherANTHEM
OH2040197Medicaid
P00075197Medicare ID - Type UnspecifiedRAILROAD
G45367Medicare UPIN
OHYE7317021Medicare ID - Type Unspecified