1336353671 NPI number — MR. MANUCHER MICHAEL FORUTAN MD

Table of content: MR. MANUCHER MICHAEL FORUTAN MD (NPI 1336353671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336353671 NPI number — MR. MANUCHER MICHAEL FORUTAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORUTAN
Provider First Name:
MANUCHER
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FORUTAN
Provider Other First Name:
M
Provider Other Middle Name:
MICHAEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336353671
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3911
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LISLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60532-8911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-717-7000
Provider Business Mailing Address Fax Number:
630-717-7011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540-6667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-717-7000
Provider Business Practice Location Address Fax Number:
630-717-7011
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC6584 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00182546 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4029503 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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