Basic Information
| Provider Information | |||||||||
| NPI: | 1467440172 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORSYTH | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 BRADY ST | ||||||||
| Address2: | |||||||||
| City: | CHESANING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486161086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898451800 | ||||||||
| FaxNumber: | 9898451820 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 BRADY ST | ||||||||
| Address2: | |||||||||
| City: | CHESANING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486161086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898451800 | ||||||||
| FaxNumber: | 9898451820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2005 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DF056603 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080730149 | 01 | MI | BCBS PROVIDER ID | OTHER | 3242856 | 05 | MI | MEDICAID |