Individual
MR. TANNER MICHAEL FULLMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2311 N PROSPECT AVE, MILWAUKEE, WI 53211-4445
(414) 319-3000
Mailing address
2311 N PROSPECT AVE, MILWAUKEE, WI 53211-4445
(414) 319-3000
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
74914
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2015
Last updated
06/18/2021
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