Individual
JOSEPH D FORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
9502 LIMA ROAD, STE 103, FORT WAYNE, IN 46818-9270
(260) 459-7313
(260) 436-0628
Mailing address
9502 LIMA ROAD, SUITE 103, FORT WAYNE, IN 46818-9270
(260) 459-7313
(260) 436-0628
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
02001553A
IN
208VP0014X
Interventional Pain Medicine Physician
Primary
02001553A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200024910A
—
IN
01
—
250008768
RR MEDICARE
IN
Enumeration date
08/11/2005
Last updated
10/18/2017
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