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NPI Code Detail

MEDICARE: MICHAEL N FULTON

MEDICARE: MICHAEL N FULTON
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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician

General Provider Information

NPI Number : 1922239110
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHAEL N FULTON
Provider Business Mailing Address
First Line : 3127 W INTERNATIONAL SPEEDWAY BLVD
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32124-1070
Country : US
Telephone Number : 386-258-9502
Fax Number : 386-239-9781
Provider Business Practice Location Address
First Line : 3127 W INTERNATIONAL SPEEDWAY BLVD
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32124-1070
Country : US
Telephone Number : 386-258-9502
Fax Number : 386-239-9781
Authorized Official
Title or Position : OWNER
Name : MICHAEL N FULTON
Credential : MD
Telephone Number : 386-258-9502
Provider Enumeration Date : 08/05/2009
Last Update Date : 08/05/2009

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