Healthcare Provider Details

I. General information

NPI: 1891139127
Provider Name (Legal Business Name): MICHELLE ONYINYE FORSON M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE STE 505
MELROSE PARK IL
60160-1626
US

IV. Provider business mailing address

675 W NORTH AVE STE 505
MELROSE PARK IL
60160-1626
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-4557
  • Fax:
Mailing address:
  • Phone: 708-450-4557
  • Fax: 708-338-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036138622
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036138622
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036138622
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: