Provider Demographics
NPI:1316055536
Name:M MICHAEL FORUTAN MD SC
Entity type:Organization
Organization Name:M MICHAEL FORUTAN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUCHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FORUTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-717-7000
Mailing Address - Street 1:PO BOX 3911
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-8911
Mailing Address - Country:US
Mailing Address - Phone:630-717-7000
Mailing Address - Fax:630-717-7011
Practice Address - Street 1:600 S WASHINGTON ST
Practice Address - Street 2:STE 300
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6667
Practice Address - Country:US
Practice Address - Phone:630-717-7000
Practice Address - Fax:630-717-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4029503OtherAETNA
P00182546OtherMEDICARE RR
D86596Medicare UPIN
210509Medicare ID - Type Unspecified