MEDICARE: WESLEY FORGUE MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1952048852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESLEY FORGUE MD LLC

Provider Business Mailing Address
First Line	:	6038 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3357
Country	:	US
Telephone Number	:	614-694-0972
Fax Number	:

Provider Business Practice Location Address
First Line	:	6038 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3357
Country	:	US
Telephone Number	:	614-694-0972
Fax Number	:	614-694-0989

Authorized Official
Title or Position	:	OWNER
Name	:	WESLEY FORGUE
Credential	:	MD
Telephone Number	:	614-694-0972

Provider Enumeration Date	:	05/13/2022
Last Update Date	:	05/16/2022

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