Provider Demographics
NPI:1154596336
Name:FORTENKO, OLGA M (MD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:M
Last Name:FORTENKO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-8752
Mailing Address - Fax:650-365-1157
Practice Address - Street 1:2347 E GALA ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4881
Practice Address - Country:US
Practice Address - Phone:208-323-3767
Practice Address - Fax:208-323-3768
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2024-05-20
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Provider Licenses
StateLicense IDTaxonomies
CAA110003207RC0200X, 207RP1001X
IDM-17729207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine