# MR. RANDALL S FORTUNA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1285607986
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 036-109764 | IL | — |
| 2086S0129X | Vascular Surgery Physician | 036109764 | IL | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 036109764 | IL | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 49534 | AZ | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | A68643 | CA | Yes |

## Other

- **Enumeration date:** 02/12/2006
- **Last updated:** 10/31/2023