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Organization

FORDEM HEALTH, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DAVID JOHN FOREIT DO (MEDICAL DIRECTOR)
(877) 757-2568
Entity
Organization

Contact information

Practice address
1313 PARK DR, MUNSTER, IN 46321-2634
(877) 757-2568
Mailing address
730 45TH AVE, MUNSTER, IN 46321-2818
(877) 757-2568

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
02001522
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1376740647
NPI NUMBER
01
256390C
MEDICARE #
Enumeration date
07/31/2016
Last updated
10/28/2020
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