Healthcare Provider Details

I. General information

NPI: 1356365431
Provider Name (Legal Business Name): LANNY STUART FOSTER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31390 NORTHWESTERN HWY STE. E
FARMINGTON HILLS MI
48334-2561
US

IV. Provider business mailing address

31390 NORTHWESTERN HWY STE. E
FARMINGTON HILLS MI
48334-2561
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-6888
  • Fax: 248-855-1068
Mailing address:
  • Phone: 248-855-6888
  • Fax: 248-855-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001152
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: