Provider Demographics
NPI:1972034908
Name:FORSTHOEFEL, KELLY JUNE (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JUNE
Last Name:FORSTHOEFEL
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 1:1405 CENTERVILLE RD STE 4200
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4622
Mailing Address - Country:US
Mailing Address - Phone:850-848-4628
Mailing Address - Fax:850-702-9727
Practice Address - Street 1:1405 CENTERVILLE RD STE 4200
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4622
Practice Address - Country:US
Practice Address - Phone:850-848-4628
Practice Address - Fax:850-702-9727
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148215207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology