Healthcare Provider Details

I. General information

NPI: 1801905773
Provider Name (Legal Business Name): ELISA M. FOSTER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISA CASTANEDA

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE
GRAYLING MI
49738-1312
US

IV. Provider business mailing address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

V. Phone/Fax

Practice location:
  • Phone: 989-348-5461
  • Fax:
Mailing address:
  • Phone: 989-348-1040
  • Fax: 989-348-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101015023
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: