Provider Demographics
NPI:1568657666
Name:MICHAEL E FOSTER MD PC
Entity Type:Organization
Organization Name:MICHAEL E FOSTER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-420-7061
Mailing Address - Street 1:5036 GOODMAN RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7905
Mailing Address - Country:US
Mailing Address - Phone:662-420-7061
Mailing Address - Fax:901-682-9998
Practice Address - Street 1:7580 CLARINGTON CV
Practice Address - Street 2:SUITE 4
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5657
Practice Address - Country:US
Practice Address - Phone:662-349-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11681208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSCG6679OtherRR MEDICARE PIN
C00773Medicare PIN
MSB64956Medicare UPIN