Provider Demographics
NPI:1417972084
Name:FOGGIA, MICHAEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:FOGGIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-4726
Mailing Address - Country:US
Mailing Address - Phone:515-262-0404
Mailing Address - Fax:515-262-0489
Practice Address - Street 1:1530 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-4726
Practice Address - Country:US
Practice Address - Phone:515-262-0404
Practice Address - Fax:515-262-0489
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N313OtherAR BCBS
AR158297003Medicaid
OK200059120AMedicaid
OK200059120AMedicaid
AR158297003Medicaid