Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Maxwell Tanyi Fohtung

Individual provider General Practice Physician · NPI 1982088571

Dr. Maxwell Tanyi Fohtung is a General Surgery in Saint Louis, Missouri. Graduated from Indiana University School of Medicine in 2015, 11 years ago. Practices with Pro Health One Inc, a 28-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Colorado and Missouri.

Years since qualifying
11
Trained at
Indiana University School of Medicine
Licensed in
CO, MO
In the registry since
2015
Specialties on file
3
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Practice location Address checks out

4949 W Pine Blvd
Saint Louis, MO 63108
Phone: (314) 389-1496
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 — (314) 362-5000

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X · Licence DR.0069226 (CO)
General Practice Physician Taxonomy 208D00000X · Licence 2018011353 (MO)
Surgery Physician Taxonomy 208600000X · Licence 2018011353 (MO)

Record details

NPI number1982088571
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 14, 2015
Last updated in NPPESMarch 31, 2026
Certification dateMarch 31, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGENERAL SURGERY
Medical schoolINDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduated 2015 (11 years in practice)
Group practice Pro Health One Inc — 28 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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