Individual
DR. KEVIN J FULLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD FACC
Contact information
Practice address
6308 8TH AVE, SUITE 3060, KENOSHA, WI 53143-5082
(262) 656-3650
(262) 656-3671
Mailing address
6308 8TH AVE, SUITE 3060, KENOSHA, WI 53143-5082
(262) 656-3650
(262) 656-3671
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
27973
WI
207RI0011X
Interventional Cardiology Physician
27973
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346224532
—
WI
05
—
30742900
—
WI
Enumeration date
12/01/2005
Last updated
08/07/2014
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