# D L FORTSON M D P C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fortson Family Care and Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184710428
- **Authorized official:** DARRYL L FORTSON M D (PRESIDENT & CEO)
- **Authorized official phone:** (219) 924-9277

## Contact information

- **Practice address:** 1950 45TH AVE, SUITE 100, MUNSTER, IN 46321-3917
- **Practice address phone:** (219) 924-9277
- **Practice address fax:** (219) 924-9281
- **Mailing address:** 1950 45TH AVE, SUITE 100, MUNSTER, IN 46321-3917
- **Mailing address phone:** (219) 924-9277
- **Mailing address fax:** (219) 924-9281

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01037803 | IN | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 12/03/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000359839 | ANTHEM, BC/BS PROVIDER | IN |