Individual
KATHLEEN M FULGENZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
24911 LITTLE MACK AVE, ST CLAIR SHORES, MI 48080-3200
(586) 777-2050
(586) 777-2189
Mailing address
43800 GARFIELD RD, CLINTON TWP, MI 48038-1136
(586) 777-2050
(586) 777-2189
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301042670
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0Q262160
BLUE CROSS
MI
05
—
4420765
—
MI
Enumeration date
08/19/2005
Last updated
02/18/2014
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