DR. MAXWELL TANYI FOHTUNG (NPI# 1982088571) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982088571 |
| Entity Type | Individual |
| Full Name | DR. MAXWELL TANYI FOHTUNG |
| Practice Address |
4949 W Pine Blvd Saint Louis MO 63108 |
| Mailing Address |
4949 W Pine Blvd Saint Louis MO 63108-1431 |
| Practice Telephone | 3143891496 |
| Mailing Telephone | 3143625000 |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2018-06-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 2018011353 | MO | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | 2018011353 | MO | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Barnes Jewish Hospital Plz, Saint Louis, MO 631101003 | 3143625000 |
| Street Address |
4949 W PINE BLVD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902347263 | Laura Bliss | Student in an Organized Health Care Education/Training Program | 4949 W Pine Blvd, Apt 3a, Saint Louis, MO 63108-1431 | 2017-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346851474 | Nigel Austen Thomas Cook | Social Worker | 4050 West Pine Blvd. Apt. 4118, St. Louis, MO 63108 | 2020-08-12 |
| 1467070011 | C2n Diagnostics, LLC | Clinical Medical Laboratory | 20 South Sarah Street, Saint Louis, MO 63108 | 2020-07-10 |
| 1609414358 | Kaylee Breitenbucher | Occupational Therapist | 4444 Forest Park Avenue, Msc 8505-94-01, St. Louis, MO 63108 | 2019-12-12 |
| 1114419546 | Activangels Home Health | Home Health | 4625 Lindell Blvd Ste 304, Saint Louis, MO 63108 | 2018-06-01 |
| 1215427349 | Heart To Heart Consolidated Home Care Service LLC | Home Health | 4625 Lindell Blvd Ste 200, Saint Louis, MO 63108 | 2018-05-15 |
| 1447755905 | Erin Virginia Adams | Student in an Organized Health Care Education/Training Program | 4355 Maryland Ave Apt 116, Saint Louis, MO 63108 | 2018-03-27 |
| 1033621172 | Roots Healthcare and Homes | In Home Supportive Care | 4300 Enright Ave, St. Louis, MO 63108 | 2017-10-30 |
| 1336661719 | House of Destiny Adult Day Care LLC | Clinic/Center | 4507 Olive Street, St Louis, MO 63108 | 2017-07-07 |
| 1003338492 | Khin Min Thu | Social Worker | 4236 Lindell Blvd., Suite 200, St Louis, MO 63108 | 2017-07-07 |
| 1679093967 | Together We Can Home Healthcare Services LLC | Home Health | 4144 Lindell Blvd Suite 221, Saint Louis, MO 63108 | 2017-06-27 |
| Find all providers in zip 63108 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790205854 | Zachary Avital Goodman | General Practice | 6642 Clayton Rd # 278, Saint Louis, MO 63117-1602 | 2017-06-20 |
| 1174926224 | Anita Dewan | General Practice | 9917 Grandview Forest Ct, Saint Louis, MO 63127-0046 | 2014-10-03 |
| 1356755201 | Jessica Ellie Ma | General Practice | 216 S Kingshighway Blvd Fl 6, 6th Floor, Saint Louis, MO 63110-1026 | 2014-06-19 |
| 1235550385 | Doctor's On The Way, Inc | General Practice | 712 N 2nd St, Ste 310, Saint Louis, MO 63102-2550 | 2013-12-16 |
| 1518398916 | John Allen Cooper | General Practice | 40 N Kingshighway Blvd Apt 13f, Saint Louis, MO 63108-1343 | 2013-12-10 |
| 1417382821 | Hyung T Kim | General Practice | 11 Crestwood Dr, Saint Louis, MO 63105-3032 | 2013-09-05 |
| 1356617443 | Kirsten Frances Dunn | General Practice | 1040 N Mason Rd Ste 103, Ste 103, Saint Louis, MO 63141-6361 | 2012-03-22 |
| 1902199623 | Care Plus Medical Group LLC | General Practice | 10650 Gateway Blvd, Saint Louis, MO 63132-1802 | 2011-05-27 |
| 1437474202 | Debra Lynne Moss | General Practice | 12929 Ballantine Ct, Saint Louis, MO 63146-3701 | 2010-04-05 |
| 1558538850 | Patrice Lynn Wakefield | General Practice | 514 Donne Ave, Saint Louis, MO 63130-3918 | 2008-05-15 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63108 |
Please comment or provide details below to improve the information on DR. MAXWELL TANYI FOHTUNG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.