Healthcare Provider Details

I. General information

NPI: 1316064488
Provider Name (Legal Business Name): JOEL D FOSTER DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 N.W. SYCAMORE ST STE A
LEES SUMMIT MO
64086-4703
US

IV. Provider business mailing address

6 N.W. SYCAMORE ST SUITE A
LEES SUMMIT MO
64086-4703
US

V. Phone/Fax

Practice location:
  • Phone: 816-246-4222
  • Fax: 816-246-4223
Mailing address:
  • Phone: 816-246-4222
  • Fax: 816-246-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2000161864
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number12-00320
License Number StateMO

VIII. Authorized Official

Name: DR. JOEL DAVID FOSTER
Title or Position: OWNER
Credential: DPM
Phone: 816-246-4222