Individual
LISA ANNE FULGENZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
26711 WOODWARD AVE STE 103, HUNTINGTON WOODS, MI 48070
(248) 543-6000
(248) 543-3770
Mailing address
26711 WOODWARD AVE STE 103, HUNTINGTON WOODS, MI 48070
(248) 543-6000
(248) 543-3770
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
LF054789
MI
208000000X
Pediatrics Physician
LF054789
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
443604010
—
MI
Enumeration date
02/08/2006
Last updated
02/03/2015
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