Individual
DR. MICHAEL PAUL FULLENKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 BARNES JEWISH HOSPITAL PLAZA, ST. LOUIS, MO 63110
(314) 294-0446
Mailing address
379 N TAYLOR AVE APT 1W, SAINT LOUIS, MO 63108-1981
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2005015807
MO
Other
Enumeration date
10/05/2006
Last updated
09/08/2009
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