Individual
DR. MICHAEL A FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3545 OLENTANGY RVR RD, SUITE 214, COLUMBUS, OH 43214-3907
(614) 263-5908
(614) 263-5941
Mailing address
3545 OLENTANGY RVR RD, SUITE 214, COLUMBUS, OH 43214-3907
(614) 263-5908
(614) 263-5941
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2928
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0426686
—
OH
Enumeration date
08/01/2005
Last updated
10/09/2012
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