Provider Demographics
NPI:1508800814
Name:FORGEY, WILLIAM WALLACE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WALLACE
Last Name:FORGEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7184
Mailing Address - Country:US
Mailing Address - Phone:219-769-6055
Mailing Address - Fax:219-769-6035
Practice Address - Street 1:109 E 89TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7184
Practice Address - Country:US
Practice Address - Phone:219-769-6055
Practice Address - Fax:219-769-6035
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND69709Medicare UPIN