MEDICARE: KAREN EDNA FORSMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	R6D15	MO

General Provider Information

NPI Number	:	1730179086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN EDNA FORSMAN M.D.

Provider Business Mailing Address
First Line	:	969 N MASON RD
Second Line	:	SUITE 235
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6338
Country	:	US
Telephone Number	:	314-469-3333
Fax Number	:	314-469-3327

Provider Business Practice Location Address
First Line	:	969 N MASON RD
Second Line	:	SUITE 235
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6338
Country	:	US
Telephone Number	:	314-469-3333
Fax Number	:	314-469-3327

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	05/06/2009

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