Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 38156-020 | WI |
N | 111NI0900X | Internist | 38156-020 | WI |
Y | 207RS0012X | Sleep Medicine | 38156-020 | WI |
NPI | 1043261399 |
---|---|
Provider Name | Allen C. Foster |
First Address | Fond Du Lac, WI 54935-4560 |
Second Address | Fond Du Lac, WI 54935-4560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 21/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32286700 | (05) | WI |
G01369 | (02) | WI |