Provider Demographics
NPI:1568439669
Name:FORMAN, SETH H (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:H
Last Name:FORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6400 FARMINGTON RD
Mailing Address - Street 2:STE 10
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-788-1200
Mailing Address - Fax:248-788-2346
Practice Address - Street 1:46325 W 12 MILE RD STE 240
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2462
Practice Address - Country:US
Practice Address - Phone:248-596-1000
Practice Address - Fax:248-305-8250
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301068662208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OF36132Medicare ID - Type Unspecified