Individual
OLGA M. FORTENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2347 E GALA ST, MERIDIAN, ID 83642-4881
(208) 323-3767
(208) 323-3768
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
(650) 365-1157
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
A110003
CA
207RP1001X
Pulmonary Disease Physician
A110003
CA
207RP1001X
Pulmonary Disease Physician
Primary
M-17729
ID
Other
Enumeration date
04/28/2008
Last updated
05/20/2024
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