Healthcare Provider Details

I. General information

NPI: 1922426329
Provider Name (Legal Business Name): JOHANNA KRISTEN FOX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOHANNA KRISTEN ERSTAD MD

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 10TH ST W
SAINT PAUL MN
55102-1062
US

IV. Provider business mailing address

2945 HAZELWOOD ST STE 200
MAPLEWOOD MN
55109-1243
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-3000
  • Fax: 651-326-3626
Mailing address:
  • Phone: 651-471-9400
  • Fax: 651-326-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number65538
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number65538
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: