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General NPI Number Information
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NPI Number | 1104479203
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Entity Type | Individual
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Provider Name | LISANDRO ROBERTO FORTUNY
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Gender | Male
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1 BARNES JEW HOSP PLZ
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1003
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Country | US
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Telephone | 314-362-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 660 S EUCLID AVE # 8118
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1010
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Country | US
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Telephone | 314-362-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0006X
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Taxonomy Name | Clinical Pathology Physician
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License Number | 036-161400
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | 2019018934
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207ZB0001X
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Taxonomy Name | Blood Banking & Transfusion Medicine Physician
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License Number | 97756
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License Number State | GA
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