Individual
DR. MAXWELL TANYI FOHTUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4949 W PINE BLVD, SAINT LOUIS, MO 63108
(314) 389-1496
Mailing address
4949 W PINE BLVD, SAINT LOUIS, MO 63108-1431
(314) 362-5000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2018011353
MO
208D00000X
General Practice Physician
2018011353
MO
208D00000X
General Practice Physician
Primary
DR.0069226
CO
Other
Enumeration date
07/14/2015
Last updated
03/31/2026
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