Provider Demographics
NPI:1124010806
Name:FORMAN, SAUL Z (MD)
Entity Type:Individual
Prefix:
First Name:SAUL
Middle Name:Z
Last Name:FORMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:28800 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2981
Mailing Address - Country:US
Mailing Address - Phone:248-932-2500
Mailing Address - Fax:248-932-2506
Practice Address - Street 1:28800 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2981
Practice Address - Country:US
Practice Address - Phone:248-932-2500
Practice Address - Fax:248-932-2506
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010280922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1166192Medicaid
MI1166192Medicaid