Provider Demographics
NPI:1063497543
Name:FOREBACK, JAMI (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMI
Middle Name:
Last Name:FOREBACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1397 S LINDEN RD
Mailing Address - Street 2:STE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4194
Mailing Address - Country:US
Mailing Address - Phone:810-720-9300
Mailing Address - Fax:810-720-9304
Practice Address - Street 1:1397 S LINDEN RD
Practice Address - Street 2:STE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4194
Practice Address - Country:US
Practice Address - Phone:810-720-9300
Practice Address - Fax:810-720-9304
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102506552OtherBLUE CROSS
MI110B56125OtherCOMMUNITY BLUE PPO
MI110B56125OtherBLUE CARE NETWORK
MI7513402OtherAETNA
MIH76499OtherHEALTH NET FEDERAL SERVIC
MI110B56125OtherBLUE CHOICE
MI14605OtherMCARE
MIH76499OtherHAP
MI0994378OtherGENESEE HEALTH PLAN
MI0994378OtherHEALTH PLUS
MI1007004OtherMCLAREN HEALTH PLAN
MI110B56125OtherBLUE CROSS BLUE SHIELD
MI1007004OtherHEALTH ADVANTAGE NETWORK
MI4458421Medicaid
MI110B56125OtherBLUE CROSS BLUE SHIELD
MI110B56125OtherBLUE CHOICE
MI110B56125OtherBLUE CARE NETWORK