Healthcare Provider Details

I. General information

NPI: 1083663504
Provider Name (Legal Business Name): LOUIS FORTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 OLD SYMSONIA RD
BENTON KY
42025-5042
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-4800
  • Fax: 270-527-4910
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number24262
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: