Individual
DR. JOHN EDWARD FORTUNATO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611
(312) 227-4200
(312) 227-9392
Mailing address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(312) 227-4200
(312) 227-9392
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
036096126
IL
2080P0206X
Pediatric Gastroenterology Physician
2006-00442
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10409276
—
VA
01
—
188686
MEDCOST
—
05
—
3810007095
—
WV
05
—
5904588
—
NC
01
—
7423644
BCBS
—
01
—
808511
PARTNERS
—
Enumeration date
05/01/2006
Last updated
05/22/2018
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