Individual
AMY L FOTHERGILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4410 REGENT ST, ASSOCIATED PHYSICIANS, LLP, MADISON, WI 53705-4901
(608) 233-9746
Mailing address
4410 REGENT ST, ASSOCIATED PHYSICIANS, LLP, MADISON, WI 53705-4901
(608) 233-9746
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
55468-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063646370
—
WI
01
—
55468-20
STATE LICENSE NUMBER
WI
Enumeration date
05/14/2009
Last updated
01/28/2014
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