Individual
MICHAEL FULKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
M352 MASS MUTUAL, 1295 STATE STREET, SPRINGFIELD, MA 01111-0001
(860) 562-1153
Mailing address
17580 CLINTON RD, JACKSON, CA 95642-9633
(860) 562-1153
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
57117
MA
Other
Enumeration date
04/03/2007
Last updated
07/08/2007
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