Provider Demographics
NPI:1356776389
Name:FORMAN, MICHAEL (AP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FORMAN
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 PURDY AVE
Mailing Address - Street 2:APT 1014
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1400
Mailing Address - Country:US
Mailing Address - Phone:305-741-2102
Mailing Address - Fax:786-364-7365
Practice Address - Street 1:1900 PURDY AVE
Practice Address - Street 2:APT 1014
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1400
Practice Address - Country:US
Practice Address - Phone:305-741-2102
Practice Address - Fax:786-364-7365
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3318171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist