Individual
MR. BRANDON FULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
747 E COUNTY LINE RD STE H, GREENWOOD, IN 46143-1082
(317) 528-8009
(317) 528-8012
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001066A
IN
363AM0700X
Medical Physician Assistant
10001066A
IN
Other
Enumeration date
05/18/2009
Last updated
07/20/2023
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