Provider Demographics
NPI:1821296054
Name:FOUTS, JOANN (DO)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:FOUTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MELBY ST
Mailing Address - Street 2:
Mailing Address - City:WESTBY
Mailing Address - State:WI
Mailing Address - Zip Code:54667-1012
Mailing Address - Country:US
Mailing Address - Phone:608-634-3126
Mailing Address - Fax:608-634-3316
Practice Address - Street 1:100 MELBY ST
Practice Address - Street 2:
Practice Address - City:WESTBY
Practice Address - State:WI
Practice Address - Zip Code:54667-1012
Practice Address - Country:US
Practice Address - Phone:608-637-3126
Practice Address - Fax:608-634-3316
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54371-021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IARES000Medicare UPIN