Healthcare Provider Details

I. General information

NPI: 1902512080
Provider Name (Legal Business Name): CRAIG A. FUELLING, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 S HILL RD
MILFORD MI
48381-3535
US

IV. Provider business mailing address

3725 S HILL RD
MILFORD MI
48381-3535
US

V. Phone/Fax

Practice location:
  • Phone: 734-455-3361
  • Fax: 734-975-1604
Mailing address:
  • Phone: 734-455-3361
  • Fax: 734-975-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CRAIG ALAN FUELLING
Title or Position: OWNER
Credential: M.D.
Phone: 734-455-3361