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Individual
UDO G FOREMAN
Active
Individual
UDO G FOREMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-02569
KS
363A00000X
Physician Assistant
2745
NE
363A00000X
Physician Assistant
3145
CO
363A00000X
Physician Assistant
5601006199
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5410563
BCBSM PIN
MI
Enumeration date
12/22/2010
Last updated
02/05/2025
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