Individual
DOUGLAS R FULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
4301063830
MI
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
4301063830
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4230027
—
MI
Enumeration date
10/18/2006
Last updated
10/24/2019
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