Individual
MICHAEL FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6490 MAIN ST, STE 1, WILLIAMSVILLE, NY 14221-5853
(716) 883-1991
Mailing address
6490 MAIN ST, STE 1, WILLIAMSVILLE, NY 14221-5853
(716) 883-1991
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
265403
NY
Other
Enumeration date
03/07/2016
Last updated
03/25/2016
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