MEDICARE: DR. JENNIFER ERICKSON-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	208600000X	Surgery Physician	53884-20	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01241795	OTHER	WI	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1952568016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER ERICKSON-FOSTER M.D.

Provider Business Mailing Address
First Line	:	720 S VANBUREN ST
Second Line	:	SUITE 201
City	:	GREEN BAY
State	:	WI
Zip	:	54301-3534
Country	:	US
Telephone Number	:	920-433-7488
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 S VANBUREN ST
Second Line	:	SUITE 201
City	:	GREEN BAY
State	:	WI
Zip	:	54301-3534
Country	:	US
Telephone Number	:	920-433-7488
Fax Number	:

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	08/19/2015

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