MEDICARE: DR. TISHA FOSTER M.D.

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	207ZB0001X	Blood Banking & Transfusion Medicine Physician	95945	FL

General Provider Information

NPI Number	:	1538289996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TISHA FOSTER M.D.

Provider Business Mailing Address
First Line	:	300 MAGNETA LOOP
Second Line	:
City	:	AUBURNDALE
State	:	FL
Zip	:	33823-9790
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-2271
Country	:	US
Telephone Number	:	863-687-8925
Fax Number	:

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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