Fuller, Brent

Fuller, Brent is an individual health care provider with primary practice located at 3535 W 13 Mile Rd Ste Ll , Royal Oak MI 48073-6770. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Fuller, Brent can be contacted via phone (248) 551-3000.

Contact Information

Primary practice address
3535 W 13 Mile Rd Ste Ll Royal Oak MI 48073-6770
Phone: (248) 551-3000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 4301070157 Michigan
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 4301070157 Michigan

Profile Details

NPI number 1871552646
LBN Legal business name Fuller, Brent
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 21st, 2006
Last updated Oct 5th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871552646 NPPES
Michigan MEDICAID 4800002
Michigan Other 110F376980

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