Individual
VINCENT P. FORTUNATO
Active
Individual
VINCENT P. FORTUNATO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R1J64
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110080662
RAILROAD MEDICARE
MO
01
—
173933
HEALTHLINK
MO
05
—
206760100
—
MO
01
—
21532
BLUE CROSS
MO
01
—
4084340
AETNA
MO
01
—
431650657
CIGNA HEALTHCARE
MO
01
—
9499441
UNITED HEALTHCARE
MO
Enumeration date
12/09/2005
Last updated
08/28/2020
Update your record
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