Fuller, Richard E

Fuller, Richard E is an individual health care provider with primary practice located at 17780 Versailles Ct , Brookfield WI 53045-5026. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adult Medicine, which is considered as his primary health care specialty. Fuller, Richard E can be contacted via phone (262) 389-1375.

Contact Information

Primary practice address
17780 Versailles Ct Brookfield WI 53045-5026
Phone: (262) 389-1375
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adult Medicine 207QA0505X 32988-020 Wisconsin

Profile Details

NPI number 1306841002
LBN Legal business name Fuller, Richard E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2005
Last updated Jun 11th, 2021 - about 4 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 1306841002 NPPES
Wisconsin MEDICAID 208000000X
Wisconsin MEDICAID 31875900
Wisconsin Other 1306841002

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