Individual
ZACHARY J FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1405 E 12TH ST STE 200, MENDOTA, IL 61342-9011
(815) 539-1710
Mailing address
102 S. HENNEPIN AVE., KSB MEDICAL GROUP, DIXON, IL 61021
(815) 285-8520
(815) 285-8903
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036111932
IL
208M00000X
Hospitalist Physician
Primary
036111932
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111932
—
IL
Enumeration date
02/06/2006
Last updated
06/29/2022
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