MEDICARE: LERON FULLERTON

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1669006524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LERON FULLERTON

Provider Business Mailing Address
First Line	:	17325 EUCLID AVE STE 4012
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-1262
Country	:	US
Telephone Number	:	216-855-1315
Fax Number	:

Provider Business Practice Location Address
First Line	:	17325 EUCLID AVE STE 4012
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-1262
Country	:	US
Telephone Number	:	216-438-3349
Fax Number	:

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

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	06/06/2024

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Directions to “ LERON FULLERTON ” Practice Location

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