Individual
MICHAEL JOHN FUMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
351 EXECUTIVE PKWY, ROCKFORD, IL 61107-5339
(815) 398-4057
Mailing address
351 EXECUTIVE PKWY, ROCKFORD, IL 61107-5339
(815) 398-4057
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036117800
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036117800
—
IL
Enumeration date
03/01/2007
Last updated
11/19/2009
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