MEDICARE: JOHN FOSS I

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1669821609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN FOSS I

Provider Business Mailing Address
First Line	:	2012 DEXTER AVE
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-4014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2012 DEXTER AVE
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-4014
Country	:	US
Telephone Number	:	231-740-2195
Fax Number	:

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

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	06/10/2016

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Directions to “ JOHN FOSS I ” Practice Location

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