Provider Demographics
NPI:1669472858
Name:FOSKETT, JAMES J (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:FOSKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2817 NEW PINERY RD.
Mailing Address - Street 2:DIVINE SAVIOR HEATHCARE, INC.
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-0387
Mailing Address - Country:US
Mailing Address - Phone:608-745-5176
Mailing Address - Fax:608-745-0451
Practice Address - Street 1:2817 NEW PINERY RD.
Practice Address - Street 2:DIVINE SAVIOR HEATHCARE, INC.
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-0387
Practice Address - Country:US
Practice Address - Phone:608-745-5176
Practice Address - Fax:608-745-0451
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-093048207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B52857Medicare UPIN
WI131350045Medicare PIN