Provider Demographics
NPI:1376584987
Name:FORESTER, MARY A (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:FORESTER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:9601 TOWNLINE RD
Mailing Address - Street 2:MARSHFIELD CLINIC
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9099
Mailing Address - Country:US
Mailing Address - Phone:715-358-1000
Mailing Address - Fax:715-358-1331
Practice Address - Street 1:9601 TOWNLINE RD
Practice Address - Street 2:MARSHFIELD CLINIC
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9099
Practice Address - Country:US
Practice Address - Phone:715-358-1000
Practice Address - Fax:715-358-1331
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI40540-0212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30088400Medicaid
WIP00050904Medicare PIN
WI30088400Medicaid
WI083574150Medicare PIN
WI032954340Medicare PIN
F86931Medicare UPIN