Individual
DR. SAM FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
(574) 247-9442
Mailing address
3600 W BETHEL AVE, MUNCIE, IN 47304-5407
Taxonomy
Speciality
Code
Description
License number
State
2086S0105X
Surgery of the Hand (Surgery) Physician
01075560A
IN
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
01075560A
IN
Other
Enumeration date
04/01/2011
Last updated
09/03/2024
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