Provider Demographics
NPI:1699273912
Name:FORSYTHE, MICHAEL JOHN (HAS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:FORSYTHE
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 ENTERPRISE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8257
Mailing Address - Country:US
Mailing Address - Phone:386-775-0220
Mailing Address - Fax:
Practice Address - Street 1:2751 ENTERPRISE RD
Practice Address - Street 2:SUITE#: 106
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-3276
Practice Address - Country:US
Practice Address - Phone:386-775-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4839237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist