Healthcare Provider Details

I. General information

NPI: 1669821609
Provider Name (Legal Business Name): JOHN FOSS I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 DEXTER AVE
ANN ARBOR MI
48103-4014
US

IV. Provider business mailing address

2012 DEXTER AVE
ANN ARBOR MI
48103-4014
US

V. Phone/Fax

Practice location:
  • Phone: 231-740-2195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: