Individual
FORTESA MYHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
800 BIESTERFIELD RD STE G01, ELK GROVE VILLAGE, IL 60007-3372
(847) 981-3680
(847) 956-5122
Mailing address
900 S FRONTAGE RD STE 325, WOODRIDGE, IL 60517-4907
(630) 972-8228
(630) 972-8229
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006125
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720371669
GROUP PRACTICE NPI
IL
01
—
DS2377
RRMC GROUP PTAN
IL
Enumeration date
10/03/2012
Last updated
12/08/2017
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