1639340177 NPI number — LANNY S. FOSTER, D.P.M., P.C.

Table of content: (NPI 1639340177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639340177 NPI number — LANNY S. FOSTER, D.P.M., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANNY S. FOSTER, D.P.M., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639340177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31390 NORTHWESTERN HWY
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48334-2561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31390 NORTHWESTERN HWY
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48334-2561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-855-6888
Provider Business Practice Location Address Fax Number:
248-855-1068
Provider Enumeration Date:
03/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
LANNY
Authorized Official Middle Name:
STUART
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-855-6888

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  5901001152 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 490003802 . This is a "RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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