Provider Demographics
NPI:1861425456
Name:AMENT, JOEL STEVEN (MD)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:STEVEN
Last Name:AMENT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 19070
Mailing Address - Street 2:PREVEA HEALTH
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-9070
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:920-433-8569
Practice Address - Street 1:835 S VAN BUREN ST
Practice Address - Street 2:ROOM 1041
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3526
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:920-433-8569
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2022-11-10
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Provider Licenses
StateLicense IDTaxonomies
FLME1419812080P0203X
CAG657062080P0203X
WI408942080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32533100Medicaid
WIE33320Medicare UPIN
WI32533100Medicaid