Provider Demographics
NPI:1235109190
Name:FOUST, KIM MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:FOUST
Suffix:
Gender:F
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:844-266-8268
Mailing Address - Fax:
Practice Address - Street 1:11300 CRESTHILL DR STE 100
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-7924
Practice Address - Country:US
Practice Address - Phone:980-302-3550
Practice Address - Fax:980-302-3551
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
75185OtherMEDCOST
NC232009OtherMEDICARE
NC891087QMedicaid
NC110166264OtherRAILROAD MEDICARE
NC1087QOtherBCBS NC
NC17582OtherPARTNERS
NC232009OtherMEDICARE
NCG01934Medicare UPIN
NC2247245AMedicare PIN