Provider Demographics
NPI:1629165311
Name:FOERTSCH, MICHAEL GEORGE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:FOERTSCH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N PORT ROYALE DR
Mailing Address - Street 2:APARTMENT 117
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7919
Mailing Address - Country:US
Mailing Address - Phone:443-910-8204
Mailing Address - Fax:
Practice Address - Street 1:3300 PORT ROYALE DR N
Practice Address - Street 2:APARTMENT 117
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7919
Practice Address - Country:US
Practice Address - Phone:443-910-8204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD742LMedicare ID - Type Unspecified