| Vincent P Fortunato Md Llc | |
|
10004 Kennerly Rd 255a Saint Louis MO 63128-2141 | |
| (314) 843-5140 | |
| (314) 843-8010 |
| Full Name | Vincent P Fortunato Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10004 Kennerly Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Vincent Fortunato (PRESIDENT) |
| Authorized Official Contact | 3148435140 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vincent P Fortunato Md Llc 10004 Kennerly Rd 255a Saint Louis MO 63128-2141 Ph: (314) 843-5140 | Vincent P Fortunato Md Llc 10004 Kennerly Rd 255a Saint Louis MO 63128-2141 Ph: (314) 843-5140 |
| NPI Number | 1033424809 |
|---|---|
| Provider Enumeration Date | 08/17/2010 |
| Last Update Date | 08/17/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033424809 | NPI | - | NPPES |
| 206760100 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | R1J64 (Missouri) | Primary |
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