Provider Demographics
NPI:1275569428
Name:MILANO, FORTUNATA GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:FORTUNATA
Middle Name:GRACE
Last Name:MILANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 13TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2614
Mailing Address - Country:US
Mailing Address - Phone:320-252-5010
Mailing Address - Fax:320-203-1855
Practice Address - Street 1:308 12TH AVE S
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2321
Practice Address - Country:US
Practice Address - Phone:763-682-4400
Practice Address - Fax:763-682-1353
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN363682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN617220200Medicaid
922241014077OtherPREFERRED ONE
333J0MIOtherBCBS
HP22457OtherHEALTH PARTNERS
1563706OtherMEDICA
123566C851OtherUCARE
1563706OtherMEDICA
MN260002140Medicare ID - Type Unspecified