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General NPI Number Information
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NPI Number | 1962639757
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Entity Type | Individual
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Provider Name | MANUEL CORREA FORTES M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 265 E ROLLINS ST STE 12000
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City | ORLANDO
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State | FL
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Zip | 32804-5571
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Country | US
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Telephone | 407-975-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 265 E ROLLINS ST STE 12000
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City | ORLANDO
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State | FL
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Zip | 32804-5571
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Country | US
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Telephone | 407-975-0200
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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 | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | ME142665
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | DR.0067125
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | D0074808
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 0101265756
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | ME142665
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License Number State | FL
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