Healthcare Provider Details

I. General information

NPI: 1205163961
Provider Name (Legal Business Name): ERIC PAUL FOREMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 S LAKE PARK AVE
HOBART IN
46342-5964
US

IV. Provider business mailing address

1354 S LAKE PARK AVE
HOBART IN
46342-5964
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-6495
  • Fax:
Mailing address:
  • Phone: 219-947-6495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000115
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: