Basic Information
| Provider Information | |||||||||
| NPI: | 1043348717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 SPRING RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304728810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 INGALLS DR | ||||||||
| Address2: | |||||||||
| City: | HARVEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604263558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083322300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085001616 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 10000772A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.