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General NPI Number Information
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NPI Number | 1386802387
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Entity Type | Individual
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Provider Name | DANIEL H FULKERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 100 NAVARRE PL STE 6600
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City | SOUTH BEND
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State | IN
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Zip | 46601-1173
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Country | US
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Telephone | 574-647-8800
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Fax | 574-647-8896
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Provider Business Mailing Address
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Address Line | 3245 HEALTH DR. SUITE 100
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City | GRANGER
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State | IN
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Zip | 46530-3245
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Country | US
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Telephone | 547-647-1840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 01068116A
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License Number State | IN
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