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Individual

DR. BRENDA R FORTUNATE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
2462 E HILL RD, SUITE 1, GRAND BLANC, MI 48439-5064
(810) 695-1234
(810) 603-3182
Mailing address
2462 E HILL RD, STE 1, GRAND BLANC, MI 48439-5427
(810) 695-1234
(810) 603-3182

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101008905
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4673868
MI
Enumeration date
09/02/2006
Last updated
11/21/2011
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