MEDICARE: JAMES J FOSKETT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	036-093048	IL

General Provider Information

NPI Number	:	1669472858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES J FOSKETT MD

Provider Business Mailing Address
First Line	:	2817 NEW PINERY RD.
Second Line	:	DIVINE SAVIOR HEATHCARE, INC.
City	:	PORTAGE
State	:	WI
Zip	:	53901-0387
Country	:	US
Telephone Number	:	608-745-5176
Fax Number	:	608-745-0451

Provider Business Practice Location Address
First Line	:	2817 NEW PINERY RD.
Second Line	:	DIVINE SAVIOR HEATHCARE, INC.
City	:	PORTAGE
State	:	WI
Zip	:	53901-0387
Country	:	US
Telephone Number	:	608-745-5176
Fax Number	:	608-745-0451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	10/07/2022

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