MEDICARE: DR. ANGELA J FOLSTAD 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	208000000X	Pediatrics Physician	58031	MN
2	208000000X	Pediatrics Physician	8116	SD
3	208000000X	Pediatrics Physician	2022033678	MO

General Provider Information

NPI Number	:	1669478582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA J FOLSTAD MD

Provider Business Mailing Address
First Line	:	2115 S FREMONT AVE STE 2900
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2233
Country	:	US
Telephone Number	:	417-820-3535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 S FREMONT AVE STE 2900
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2233
Country	:	US
Telephone Number	:	417-820-3535
Fax Number	:

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	09/29/2022

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