D L Fortson M D P C

NPI #1184710428 in Munster, Indiana

Provider Information

NPI Number
1184710428
Entity Type
Organization
Organization Name
D L Fortson M D P C
Primary Specialty
Family Medicine
Enumeration Date
Oct 5, 2006
Last Updated
Dec 3, 2007

Practice Location

Address
1950 45TH AVE
Address 2
SUITE 100
State
Indiana
ZIP Code
46321-3917
Phone
(219) 924-9277

Authorized Official

Name
DARRYL L FORTSON, M D
Title
PRESIDENT & CEO
Phone
(219) 924-9277

Specialties & Taxonomy Codes

Specialty
Family Medicine

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