MEDICARE: JANYNE EDITH ALTHAUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	D0058352	MD
2	207VM0101X	Maternal & Fetal Medicine Physician	DR.0066947	CO
3	207VM0101X	Maternal & Fetal Medicine Physician	1631-320	WI

General Provider Information

NPI Number	:	1033119698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANYNE EDITH ALTHAUS MD

Provider Business Mailing Address
First Line	:	PO BOX 22487
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54305-2487
Country	:	US
Telephone Number	:	920-445-7222
Fax Number	:	920-445-7289

Provider Business Practice Location Address
First Line	:	6071 E WOODMEN RD STE 440
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2614
Country	:	US
Telephone Number	:	719-571-4590
Fax Number	:	719-571-4591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	12/07/2021

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