Individual
DR. JONATHAN M FOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2200 FORT JESSE RD, NORMAL, IL 61761-6286
(309) 452-1788
Mailing address
2200 FORT JESSE RD, NORMAL, IL 61761-6286
(309) 287-0096
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36085058
IL
2085R0202X
Diagnostic Radiology Physician
ME161552
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085058*2
—
IL
Enumeration date
06/05/2006
Last updated
10/16/2023
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