Provider Demographics
NPI:1720010481
Name:FOSTER, TERRI L (DPM)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:FOSTER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4440 LINCOLN HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2349
Mailing Address - Country:US
Mailing Address - Phone:708-481-3338
Mailing Address - Fax:708-481-8643
Practice Address - Street 1:4440 LINCOLN HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2349
Practice Address - Country:US
Practice Address - Phone:708-481-3338
Practice Address - Fax:708-481-8643
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL016004138213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0060001584OtherBCBS
IL480031781OtherRAILROAD MEDICARE
ILK34288Medicare PIN
IL480031781OtherRAILROAD MEDICARE