Provider Demographics
NPI:1083844187
Name:FORTUNATO, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:FORTUNATO
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:VALLEY ANESTHESIOLOGY CONSULTANTS
Mailing Address - Street 2:10120 S. EASTERN AVE., SUITE 130
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-487-6510
Mailing Address - Fax:702-405-7960
Practice Address - Street 1:VALLEY ANESTHESIOLOGY CONSULTANTS
Practice Address - Street 2:10120 S. EASTERN AVE., SUITE 130
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-487-6510
Practice Address - Fax:702-405-7960
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT195796207L00000X
NV14625207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology