Provider Demographics
NPI:1255312047
Name:FORSMAN, KENNETH (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:FORSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:551 LINN ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1595
Mailing Address - Country:US
Mailing Address - Phone:269-686-5800
Mailing Address - Fax:269-686-5899
Practice Address - Street 1:551 LINN ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1595
Practice Address - Country:US
Practice Address - Phone:269-686-5800
Practice Address - Fax:269-686-5899
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIKF053710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080701206-1OtherBCBS
MI17121OtherHEALTH PLAN OF MI
MI4959589Medicaid
MIP55310OtherBLUE CARE NETWORK
MI7394OtherCOMMUNITY CHOICE OF MI
MI838570OtherUNITED HEALTHCARE
MIKF053710OtherSTATE LICENSE #
MI01-31205OtherPHP PROV #
MI080085320OtherRAILROAD MEDICARE
MI838570OtherUNITED HEALTHCARE
MIP39040034Medicare PIN