Healthcare Provider Details

I. General information

NPI: 1568657666
Provider Name (Legal Business Name): MICHAEL E FOSTER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 CLARINGTON CV SUITE 4
SOUTHAVEN MS
38671-5657
US

IV. Provider business mailing address

5036 GOODMAN RD SUITE 116
OLIVE BRANCH MS
38654-7905
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-5911
  • Fax:
Mailing address:
  • Phone: 662-420-7061
  • Fax: 901-682-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11681
License Number StateMS

VIII. Authorized Official

Name: DR. MICHAEL E FOSTER
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 662-420-7061