Healthcare Provider Details

I. General information

NPI: 1821296054
Provider Name (Legal Business Name): JOANN FOUTS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MELBY ST
WESTBY WI
54667-1012
US

IV. Provider business mailing address

100 MELBY ST
WESTBY WI
54667-1012
US

V. Phone/Fax

Practice location:
  • Phone: 608-637-3126
  • Fax: 608-634-3316
Mailing address:
  • Phone: 608-634-3126
  • Fax: 608-634-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number54371-021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: