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General NPI Number Information
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NPI Number | 1114356029
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Entity Type | Organization
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Legal Business Name | FORWARD MEDICAL WEIGHT LOSS LLC
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | N112W15568 MEQUON RD # 6
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City | GERMANTOWN
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State | WI
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Zip | 53022-3413
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Country | US
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Telephone | 262-313-8375
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Fax | 262-255-1482
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Provider Business Mailing Address
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Address Line | N112W15568 MEQUON RD # 6
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City | GERMANTOWN
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State | WI
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Zip | 53022-3413
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Country | US
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Telephone | 262-313-8375
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Fax | 262-255-1482
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Authorized Official
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Title or Position | APNP
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Name | LINDSAY ANN CARMODY
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Credential | APNP
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Telephone | 414-350-6807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 3690-033
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License Number State | WI
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