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General NPI Number Information
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NPI Number | 1992734578
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Entity Type | Organization
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Legal Business Name | FORUM MEDICAL CLINIC, PC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 43184 DEQUINDRE RD STE 202
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1709
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Country | US
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Telephone | 586-580-0280
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Fax | 586-580-0281
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Provider Business Mailing Address
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Address Line | 43184 DEQUINDRE RD STE 202
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1709
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Country | US
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Telephone | 586-580-0280
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Fax | 586-580-0281
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. NICOLAS A MARSHEH IV
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Credential | M.D.
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Telephone | 586-580-0280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | NM 069838
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License Number State | MI
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