Healthcare Provider Details

I. General information

NPI: 1558449538
Provider Name (Legal Business Name): JAN ANDRIES HERHOLDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-4294
US

IV. Provider business mailing address

181 SETTINGS BLVD
BLACK MOUNTAIN NC
28711-8835
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8100
  • Fax: 608-262-6247
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberV6183
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number419222
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number82470
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: