Provider Demographics
NPI:1487256921
Name:FOREMAN, ANITA (MOL)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:MOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 W DUSSEL DR # 193
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4208
Mailing Address - Country:US
Mailing Address - Phone:567-218-0195
Mailing Address - Fax:
Practice Address - Street 1:500 MADISON AVE STE 300
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1257
Practice Address - Country:US
Practice Address - Phone:567-218-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty