1629165311 NPI number — DR. MICHAEL GEORGE FOERTSCH PSYD

Table of content: DR. MICHAEL GEORGE FOERTSCH PSYD (NPI 1629165311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629165311 NPI number — DR. MICHAEL GEORGE FOERTSCH PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOERTSCH
Provider First Name:
MICHAEL
Provider Middle Name:
GEORGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
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:
1629165311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 N PORT ROYALE DR
Provider Second Line Business Mailing Address:
APARTMENT 117
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-7919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-910-8204
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 PORT ROYALE DR N
Provider Second Line Business Practice Location Address:
APARTMENT 117
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308-7919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-910-8204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2006

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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