Organization
D L FORTSON M D P C
Active
Other names
Fortson Family Care and Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
DARRYL L FORTSON M D (PRESIDENT & CEO)
(219) 924-9277
Entity
Organization
Contact information
Practice address
1950 45TH AVE, SUITE 100, MUNSTER, IN 46321-3917
(219) 924-9277
(219) 924-9281
Mailing address
1950 45TH AVE, SUITE 100, MUNSTER, IN 46321-3917
(219) 924-9277
(219) 924-9281
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01037803
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000359839
ANTHEM, BC/BS PROVIDER
IN
Enumeration date
10/05/2006
Last updated
12/03/2007
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