Healthcare Provider Details

I. General information

NPI: 1154465649
Provider Name (Legal Business Name): MICHELLE DIANE FOSTER-DUMM INDEPENDENT DUTY HS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14750 NW 44TH CT
OPA LOCKA FL
33054-2304
US

IV. Provider business mailing address

14750 NW 44TH CT
OPA LOCKA FL
33054-2304
US

V. Phone/Fax

Practice location:
  • Phone: 305-953-2262
  • Fax:
Mailing address:
  • Phone: 305-953-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: