Provider Demographics
NPI:1528035243
Name:VANSLOUN, JOAN A (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:A
Last Name:VANSLOUN
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 1:1600 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-1631
Mailing Address - Country:US
Mailing Address - Phone:414-350-9354
Mailing Address - Fax:
Practice Address - Street 1:1600 SUNSET DR
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-1631
Practice Address - Country:US
Practice Address - Phone:414-350-9354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036136887207L00000X
MN56443207L00000X
WI34680207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31960300Medicaid
F64381Medicare UPIN
WI31960300Medicaid