Healthcare Provider Details

I. General information

NPI: 1730179086
Provider Name (Legal Business Name): KAREN EDNA FORSMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 N MASON RD SUITE 235
SAINT LOUIS MO
63141-6338
US

IV. Provider business mailing address

969 N MASON RD SUITE 235
SAINT LOUIS MO
63141-6338
US

V. Phone/Fax

Practice location:
  • Phone: 314-469-3333
  • Fax: 314-469-3327
Mailing address:
  • Phone: 314-469-3333
  • Fax: 314-469-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR6D15
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: