Provider Demographics
NPI:1497764518
Name:FORTSAS, MICHAEL N (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:FORTSAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27750 W HIGHWAY 22 STE 220
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1924
Practice Address - Country:US
Practice Address - Phone:815-206-5700
Practice Address - Fax:847-382-1771
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31700207RC0000X
IL036090812207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090812Medicaid
WI82223400Medicaid
ILIL2263001Medicare PIN
ILIL2262001Medicare PIN