Provider Demographics
NPI:1114356029
Name:FORWARD MEDICAL WEIGHT LOSS LLC
Entity type:Organization
Organization Name:FORWARD MEDICAL WEIGHT LOSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APNP
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARMODY
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:414-350-6807
Mailing Address - Street 1:N112W15568 MEQUON RD # 6
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3413
Mailing Address - Country:US
Mailing Address - Phone:262-313-8375
Mailing Address - Fax:262-255-1482
Practice Address - Street 1:N112W15568 MEQUON RD # 6
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3413
Practice Address - Country:US
Practice Address - Phone:262-313-8375
Practice Address - Fax:262-255-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3690-033261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service