Basic Information
Provider Information | |||||||||
NPI: | 1487896353 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FORREST | ||||||||
FirstName: | MARIA | ||||||||
MiddleName: | DEL CARMEN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DEL CARMEN FORREST | ||||||||
OtherFirstName: | MARIA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1613 HARRISON PKWY | ||||||||
Address2: | SUITE 200, MAILSTOP SH-9A | ||||||||
City: | SUNRISE | ||||||||
State: | FL | ||||||||
PostalCode: | 333232896 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9548382371 | ||||||||
FaxNumber: | 9548511746 | ||||||||
Practice Location | |||||||||
Address1: | 2799 W GRAND BLVD | ||||||||
Address2: |   | ||||||||
City: | DETROIT | ||||||||
State: | MI | ||||||||
PostalCode: | 482022608 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8006536568 | ||||||||
FaxNumber: | 3139169867 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/24/2009 | ||||||||
LastUpdateDate: | 06/29/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/29/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 4301106878 | MI | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 390200000X | TRN11363 | FL | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207LP3000X | 4301106878 | MI | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
No ID Information.