MEDICARE: TIMOTHY J FORNESS MDPA

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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	ME71975	FL

General Provider Information

NPI Number	:	1942397005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY J FORNESS MDPA

Provider Business Mailing Address
First Line	:	2655 S BAYSHORE DR APT 514
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-5416
Country	:	US
Telephone Number	:	305-285-3427
Fax Number	:	305-285-3427

Provider Business Practice Location Address
First Line	:	2655 S BAYSHORE DR APT 514
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-5416
Country	:	US
Telephone Number	:	305-285-3427
Fax Number	:	305-285-3427

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY J FORNESS
Credential	:	MD
Telephone Number	:	305-285-3427

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	08/21/2007

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