Healthcare Provider Details

I. General information

NPI: 1659663557
Provider Name (Legal Business Name): BRENNAN MICHEAL FORWARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3284 51ST ST S UNIT 3
FARGO ND
58104-7983
US

IV. Provider business mailing address

3284 51ST ST S UNIT 3
FARGO ND
58104-7983
US

V. Phone/Fax

Practice location:
  • Phone: 701-532-2242
  • Fax:
Mailing address:
  • Phone: 701-532-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58335
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13334
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: