Individual
MICHAEL FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8248 S 96TH ST, LA VISTA, NE 68128-3126
(402) 717-9500
(402) 717-9501
Mailing address
PO BOX 642117, OMAHA, NE 68164-8117
(402) 398-6254
(402) 829-8513
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19947
NE
Other
Enumeration date
01/11/2007
Last updated
01/15/2015
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