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General NPI Number Information
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NPI Number | 1568657666
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Entity Type | Organization
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Legal Business Name | MICHAEL E FOSTER MD PC
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 7580 CLARINGTON CV SUITE 4
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5657
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Country | US
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Telephone | 662-349-5911
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Fax |
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Provider Business Mailing Address
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Address Line | 5036 GOODMAN RD SUITE 116
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-7905
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Country | US
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Telephone | 662-420-7061
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Fax | 901-682-9998
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. MICHAEL E FOSTER
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Credential | M.D.
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Telephone | 662-420-7061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 11681
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License Number State | MS
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