=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316902570
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE KAY FOTH MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 08/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5155 E FARNESS DR SUITE 111-C
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-326-3434
-----------------------------------------------------
Fax | 520-326-0147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5155 E FARNESS DR SUITE 111-C
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-326-3434
-----------------------------------------------------
Fax | 520-326-0147
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 33562
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------