Provider Demographics
NPI:1922426329
Name:FOX, JOHANNA KRISTEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:KRISTEN
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHANNA
Other - Middle Name:KRISTEN
Other - Last Name:ERSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2945 HAZELWOOD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1243
Mailing Address - Country:US
Mailing Address - Phone:651-471-9400
Mailing Address - Fax:651-326-3626
Practice Address - Street 1:45 10TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1062
Practice Address - Country:US
Practice Address - Phone:651-232-3000
Practice Address - Fax:651-326-3626
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN65538208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery