Individual
DR. JOHN M FULTZ II
Active
Individual
DR. JOHN M FULTZ II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036042979
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036042979
—
IL
01
—
14D0876728
CLIA ID MEDICARE
IL
01
—
21608069
BCBS INS ID
IL
01
—
363179161
TAX ID
IL
01
—
792111199
RAILROAD MEDICARE ID
IL
Enumeration date
09/27/2006
Last updated
01/06/2017
Update your record
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