Provider Demographics
NPI:1316204407
Name:FOWLER, EMILY RENEE JOHNSON (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:RENEE JOHNSON
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-1950
Practice Address - Country:US
Practice Address - Phone:608-263-8100
Practice Address - Fax:608-262-6247
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56937207L00000X
MN106995207L00000X
WI67422207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
MN050002752Medicare PIN