Provider Demographics
NPI:1801091491
Name:DAVID H FORST MD PC
Entity type:Organization
Organization Name:DAVID H FORST MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERSICHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-964-9150
Mailing Address - Street 1:44199 DEQUINDRE RD STE 116
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1128
Mailing Address - Country:US
Mailing Address - Phone:248-964-9150
Mailing Address - Fax:248-964-9154
Practice Address - Street 1:44199 DEQUINDRE RD
Practice Address - Street 2:SUITE #116
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1128
Practice Address - Country:US
Practice Address - Phone:248-964-9150
Practice Address - Fax:248-964-9154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042877207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3081479 TYPE #10Medicaid
MIB44526Medicare UPIN
MI3081479 TYPE #10Medicaid