Provider Demographics
NPI:1194772855
Name:FOK, JOSEPH S (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:FOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GRAY FOX CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1856
Mailing Address - Country:US
Mailing Address - Phone:608-843-6006
Mailing Address - Fax:
Practice Address - Street 1:2925 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-262-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN62043207V00000X
WI22361-020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30300700Medicaid
WI009374150Medicare PIN
WI160021213Medicare PIN
WI006657085Medicare PIN
B52839Medicare UPIN
WI163OtherDEAN HEALTH INSURANCE
WI009374150Medicare PIN