Provider Demographics
NPI:1629196191
Name:DAVID A FORSTER D.O. P.C.
Entity Type:Organization
Organization Name:DAVID A FORSTER D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-858-3939
Mailing Address - Street 1:44555 WOODWARD AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-858-3939
Mailing Address - Fax:248-858-3844
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-858-3939
Practice Address - Fax:248-858-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1836100Medicaid
MI1836100Medicaid
MI5822674Medicare PIN