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General NPI Number Information
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NPI Number | 1477511541
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Entity Type | Individual
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Provider Name | JOHN EDWARD FORTUNATO JR. MD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 225 E CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-227-4200
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Fax | 312-227-9392
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Provider Business Mailing Address
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Address Line | 225 E CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-227-4200
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Fax | 312-227-9392
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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 | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 2006-00442
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 036096126
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License Number State | IL
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