1538109020 NPI number — THOMAS JOSEPH FORBES MD

Table of content: THOMAS JOSEPH FORBES MD (NPI 1538109020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538109020 NPI number — THOMAS JOSEPH FORBES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORBES
Provider First Name:
THOMAS
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538109020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 ST. ANTOINE - UHC 5D MAILBOX 226
Provider Second Line Business Mailing Address:
UNIVERSITY PEDIATRICIANS
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48201-2153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-745-4405
Provider Business Mailing Address Fax Number:
313-966-0665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHILDRENS HOSPITAL MI CARDIOLOGY
Provider Second Line Business Practice Location Address:
3901 BEAUBIEN 2ND FLOOR - MAIN BUILDING
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-966-8008
Provider Business Practice Location Address Fax Number:
313-993-0894
Provider Enumeration Date:
06/07/2006

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: 208000000X , with the licence number:  4301070894 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X , with the licence number: 4301070894 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 113619900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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