Individual
LOUIS M FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 SOUTH DRIVE, WINNEBAGO MENTAL HEALTH INFORMATION, WINNEBAGO, WI 54985-0009
(920) 235-4910
(920) 235-2931
Mailing address
1300 SOUTH DRIVE, WINNEBAGO, WI 54985
(920) 235-4910
(920) 237-2043
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
41378
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
626325900
—
MN
Enumeration date
10/01/2005
Last updated
05/11/2018
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