Provider Demographics
NPI:1033119698
Name:ALTHAUS, JANYNE EDITH (MD)
Entity Type:Individual
Prefix:
First Name:JANYNE
Middle Name:EDITH
Last Name:ALTHAUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:6071 E WOODMEN RD STE 440
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2614
Practice Address - Country:US
Practice Address - Phone:719-571-4590
Practice Address - Fax:719-571-4591
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0058352207VM0101X
CODR.0066947207VM0101X
WI1631-320207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G71500Medicare UPIN