Provider Demographics
NPI:1619119252
Name:FORTUN, CHAD MICHAEL (M D)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:MICHAEL
Last Name:FORTUN
Suffix:
Gender:M
Credentials:M D
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Other - First Name:
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Mailing Address - Street 1:1717 SHIPYARD BLVD STE 350
Mailing Address - Street 2:CAROLINA SPORTS MEDICINE
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-799-0110
Mailing Address - Fax:910-799-1958
Practice Address - Street 1:1202 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7307
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-2067
Is Sole Proprietor?:No
Enumeration Date:2009-03-28
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2015-01168207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine