Individual
WAYNE A FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 CLINTON ST, MUSKEGON, MI 49442-5502
(231) 726-3511
Mailing address
550 W WESTERN AVE, SUITE B, MUSKEGON, MI 49440-1045
(231) 726-4498
(231) 726-4468
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
WF091854
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578703252
—
MI
01
—
MI1878017
MEDICARE ID-TYPE UNSPECIFIED
MI
Enumeration date
10/14/2005
Last updated
02/28/2012
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