MEDICARE: MARYANN THERESE FUMO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01036532A	IN

General Provider Information

NPI Number	:	1316001480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN THERESE FUMO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	8865 W 400 N STE 130
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-9596
Country	:	US
Telephone Number	:	219-879-5143
Fax Number	:	219-872-2395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	04/13/2023

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