Individual
JANE E FOSSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1905 HUEBBE PKWY, BELOIT, WI 53511-1842
(608) 364-2293
(608) 364-2700
Mailing address
1905 HUEBBE PKWY, BELOIT, WI 53511-1842
(608) 364-2293
(608) 364-2700
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
20990020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10637
DEAN HEALTH PLAN HMO
—
05
—
30105800
—
WI
Enumeration date
08/04/2006
Last updated
08/21/2007
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