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Individual

EDWARD STEVEN FULLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
22101 MOROSS ROAD, DETROIT, MI 48236-2172
(313) 343-6866
Mailing address
5041 YANKEE, ST. CLAIR, MI 48079
(810) 329-6435

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601002984
MI

Other

Enumeration date
01/08/2007
Last updated
07/08/2007
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