Basic Information
| Provider Information | |||||||||
| NPI: | 1891139127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORSON | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | ONYINYE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1460 SIX POINTS XING APT 301 | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532144984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734403633 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8701 W WATERTOWN PLANK RD DEPT OF | ||||||||
| Address2: | |||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149550437 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2013 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 036138622 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 036138622 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1891139127 | 05 | IL | MEDICAID | FF5759507 | 01 | IL | DEA | OTHER |