Provider Demographics
NPI:1194347591
Name:RAPP, FORREST ALEXANDER (DO)
Entity type:Individual
Prefix:
First Name:FORREST
Middle Name:ALEXANDER
Last Name:RAPP
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 N CAMPBELL RD APT 206
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1535
Mailing Address - Country:US
Mailing Address - Phone:248-563-2709
Mailing Address - Fax:
Practice Address - Street 1:1142 N CAMPBELL RD APT 206
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1535
Practice Address - Country:US
Practice Address - Phone:248-563-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101028562208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program