Healthcare Provider Details

I. General information

NPI: 1154729689
Provider Name (Legal Business Name): MICHAEL FOREMAN LBSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RIVER PLACE DR SUITE 250
DETROIT MI
48207-4274
US

IV. Provider business mailing address

23163 FARMINGTON RD
FARMINGTON MI
48336-3922
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-2337
  • Fax: 313-871-1805
Mailing address:
  • Phone: 248-476-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number802018803
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: