MEDICARE: DR. MICHAEL FOREIT D.O.

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	208D00000X	General Practice Physician	02001909A	IN

General Provider Information

NPI Number	:	1891832929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL FOREIT D.O.

Provider Business Mailing Address
First Line	:	7501 W. 15TH AVE.
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46406
Country	:	US
Telephone Number	:	219-977-2090
Fax Number	:	219-977-2091

Provider Business Practice Location Address
First Line	:	7501 W. 15TH AVE.
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46406
Country	:	US
Telephone Number	:	219-977-2090
Fax Number	:	219-977-2091

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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