Healthcare Provider Details

I. General information

NPI: 1720121585
Provider Name (Legal Business Name): BRETT EMERSON FORTUNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NW 9TH AVE
MIAMI FL
33136-1101
US

IV. Provider business mailing address

1100 S MIAMI AVE APT 1201
MIAMI FL
33130-4163
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-5000
  • Fax:
Mailing address:
  • Phone: 614-425-7407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35088963
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberME177299
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number283730
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number051154
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: