Provider Demographics
NPI:1881868347
Name:FOURMAN, MATTHEW MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:FOURMAN
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 1:333 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:734-430-3200
Mailing Address - Fax:734-430-3201
Practice Address - Street 1:730 N MACOMB ST STE 415
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2904
Practice Address - Country:US
Practice Address - Phone:734-430-3200
Practice Address - Fax:734-430-3201
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098301208600000X
IN01075147A208600000X
MI4301083501208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067263Medicaid
OHH149140Medicare PIN
OH35098301OtherOHIO MEDICAL LICENSE