Healthcare Provider Details

I. General information

NPI: 1275751380
Provider Name (Legal Business Name): UROLOGY MIDWEST LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 05/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 S LAFAYETTE AVE
SEDALIA MO
65301-7541
US

IV. Provider business mailing address

1715 S LAFAYETTE AVE
SEDALIA MO
65301-7541
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-7077
  • Fax: 660-826-4202
Mailing address:
  • Phone: 660-826-7077
  • Fax: 660-826-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberR6D16
License Number StateMO

VIII. Authorized Official

Name: DR. ROBERT STEPHEN FOSTER
Title or Position: OWNER
Credential: M.D.
Phone: 660-826-7077