Provider Demographics
NPI:1922151117
Name:FOREMAN, MICHAEL TRENT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TRENT
Last Name:FOREMAN
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 1:7531 SO STONY ISLAND
Mailing Address - Street 2:ST 176
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649
Mailing Address - Country:US
Mailing Address - Phone:773-947-7746
Mailing Address - Fax:773-947-7751
Practice Address - Street 1:7531 SO STONY ISLAND
Practice Address - Street 2:ST 176
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649
Practice Address - Country:US
Practice Address - Phone:773-947-7746
Practice Address - Fax:773-947-7751
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E91471Medicare UPIN