MEDICARE: JAMES KENNETH FORTMAN II M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	35-090947	OH
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	35.090947	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000312885	OTHER	UNISON

General Provider Information

NPI Number	:	1477768208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES KENNETH FORTMAN II M.D.

Provider Business Mailing Address
First Line	:	3200 BURNET AVE
Second Line	:	3 SOUTH
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3019
Country	:	US
Telephone Number	:	513-585-5503
Fax Number	:	513-585-5511

Provider Business Practice Location Address
First Line	:	7759 UNIVERSITY DR
Second Line	:	SUITE C
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-6578
Country	:	US
Telephone Number	:	513-475-8262
Fax Number	:	513-475-8283

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	12/27/2012

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