Provider Demographics
NPI:1013760222
Name:FOREVER FOY PLLC
Entity type:Organization
Organization Name:FOREVER FOY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-731-7414
Mailing Address - Street 1:18161 W 13 MILE RD STE C2
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1113
Mailing Address - Country:US
Mailing Address - Phone:248-731-7414
Mailing Address - Fax:248-234-6337
Practice Address - Street 1:18161 W 13 MILE RD STE C2
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1113
Practice Address - Country:US
Practice Address - Phone:248-731-7414
Practice Address - Fax:248-234-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty