Individual
DR. LISA WAGNER FORREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1850 WHITES RD, KALAMAZOO, MI 49008-4801
(269) 343-3900
Mailing address
2752 CLOYSTER CT, KALAMAZOO, MI 49008-2339
(269) 492-0240
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301057603
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C910950
BCBSM
MI
05
—
1821051822
—
MI
Enumeration date
04/10/2006
Last updated
04/14/2009
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