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Organization

VINCENT P FORTUNATO MD LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. VINCENT FORTUNATO M.D. (PRESIDENT)
(314) 843-5140
Entity
Organization

Contact information

Practice address
10004 KENNERLY RD, 255A, SAINT LOUIS, MO 63128-2141
(314) 843-5140
(314) 843-8010
Mailing address
10004 KENNERLY RD, 255A, SAINT LOUIS, MO 63128-2141
(314) 843-5140
(314) 843-8010

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R1J64
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
206760100
MO
Enumeration date
08/17/2010
Last updated
08/17/2010
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