Individual
MARY DANA FOGGETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2414 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3129
(920) 457-4461
(920) 459-1483
Mailing address
2414 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3129
(920) 457-4461
(920) 459-1483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036112948
IL
207Q00000X
Family Medicine Physician
Primary
53914-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
05
—
036112948
—
IL
05
—
100011708
—
WI
Enumeration date
07/05/2006
Last updated
09/18/2023
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