Provider Demographics
NPI:1760650451
Name:FORREST, MAUREEN ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:ELAINE
Last Name:FORREST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3893 S MICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9345
Mailing Address - Country:US
Mailing Address - Phone:734-665-7303
Mailing Address - Fax:
Practice Address - Street 1:3893 S MICHAEL RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9345
Practice Address - Country:US
Practice Address - Phone:734-665-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010340112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology