Basic Information
| Provider Information | |||||||||
| NPI: | 1033783634 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FORST | ||||||||
| FirstName: | MADELINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4880 LODGE LN | ||||||||
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| City: | GREENWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553319230 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | PARKLAND HOSPITAL - MOODY OUTPATIENT CLINIC | ||||||||
| Address2: | 5151 MAPLE AVENUE | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145908000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2021 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | PA14034 | TX | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.