Provider Demographics
NPI:1780689356
Name:FORSTHOEFEL, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FORSTHOEFEL
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 1:1300 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4661
Mailing Address - Country:US
Mailing Address - Phone:850-216-0100
Mailing Address - Fax:850-216-0126
Practice Address - Street 1:1300 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4661
Practice Address - Country:US
Practice Address - Phone:850-216-0100
Practice Address - Fax:850-216-0126
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42428207R00000X
GA021978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLUNIVERSAL HLTH CAREOtherINSURANCE NETWORK
FLSOUTH CAREOtherINSURANCE NETWORK
FLVISTAOtherINSURANCE NETWORK
FL067878100Medicaid
GA00417557AMedicaid
FLBLUECROSS/BLUE SHLDOther37453
FLUNITED HEALTH CAREOtherINSURANCE NETWORK
FLVISTAOtherINSURANCE NETWORK
D29493Medicare UPIN