Provider Demographics
NPI:1396703070
Name:FOSTER, WENDY L (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 LAKE ST
Mailing Address - Street 2:STE L-120
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1876
Mailing Address - Country:US
Mailing Address - Phone:708-488-1919
Mailing Address - Fax:708-488-2370
Practice Address - Street 1:7411 LAKE ST
Practice Address - Street 2:STE L-120
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1876
Practice Address - Country:US
Practice Address - Phone:708-488-1919
Practice Address - Fax:708-488-2370
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001634609OtherBCBS OF IL GROUP
ILP00279622OtherRAILROAD MEDICARE
IL036078115Medicaid
ILK09293Medicare PIN