Provider Demographics
NPI:1861525941
Name:KAREN E. FORSMAN MD DERMATOLOGY LLC
Entity type:Organization
Organization Name:KAREN E. FORSMAN MD DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FORSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-469-3333
Mailing Address - Street 1:3 BARCLAY WOODS
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1108
Mailing Address - Country:US
Mailing Address - Phone:314-989-0699
Mailing Address - Fax:
Practice Address - Street 1:969 N MASON RD
Practice Address - Street 2:SUITE 235
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6338
Practice Address - Country:US
Practice Address - Phone:314-469-3333
Practice Address - Fax:314-469-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE81499Medicare UPIN