Fordem Health, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

02001522 Issued in IN

Legal business name

FORDEM HEALTH, LLC

Practice address

1313 Park Dr
Munster, IN 46321-2634

Phone

(877) 757-2568

NPI assigned

Jul 31, 2016

Reactivated

Oct 28, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David John Foreit, DO

Title

Medical Director

Phone

(877) 757-2568

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1639622236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 45TH AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212818",
            "telephone_number": "877-757-2568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 PARK DR",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212634",
            "telephone_number": "877-757-2568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORDEM HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-31",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "deactivation_date": "2020-10-05",
        "reactivation_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "FOREIT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "877-757-2568",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IN",
            "license": "02001522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1376740647",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE #",
            "identifier": "256390C",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Munster, IN
• Providers in Munster, IN by specialty
• Medical Specialty Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.