Individual
DR. MICHAEL ALAN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1044 N FRANCISCO AVE, CHICAGO, IL 60622-2743
(773) 292-8200
Mailing address
9405 60TH AVE, ELMHURST, NY 11373-5069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
125.083214
IL
Other
Enumeration date
04/25/2024
Last updated
04/25/2024
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