Provider Demographics
NPI:1477749240
Name:FORTUNA, MILIXA (MD)
Entity Type:Individual
Prefix:DR
First Name:MILIXA
Middle Name:
Last Name:FORTUNA
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 1:7500 4TH AVE
Mailing Address - Street 2:APT. D1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3237
Mailing Address - Country:US
Mailing Address - Phone:914-220-2449
Mailing Address - Fax:
Practice Address - Street 1:7500 4TH AVE
Practice Address - Street 2:APT. D1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3237
Practice Address - Country:US
Practice Address - Phone:914-220-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247386207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine