MEDICARE: MICHAEL FOSSEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	4301046371	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205822756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL FOSSEL MD

Provider Business Mailing Address
First Line	:	9464 CONSERVATION ST NE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9752
Country	:	US
Telephone Number	:	616-676-8779
Fax Number	:

Provider Business Practice Location Address
First Line	:	9464 CONSERVATION ST NE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9752
Country	:	US
Telephone Number	:	616-676-8779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	05/09/2012

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