MEDICARE: BARBARA L FULLER MD

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	207RH0003X	Hematology & Oncology Physician	036056161	IL
2	207RH0003X	Hematology & Oncology Physician	01034701A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972545804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA L FULLER MD

Provider Business Mailing Address
First Line	:	1600 S LAKE PARK AVE
Second Line	:	SUITE 1101
City	:	HOBART
State	:	IN
Zip	:	46342-6641
Country	:	US
Telephone Number	:	219-947-1795
Fax Number	:	219-947-9834

Provider Business Practice Location Address
First Line	:	1600 S LAKE PARK AVE
Second Line	:	SUITE1101
City	:	HOBART
State	:	IN
Zip	:	46342-6641
Country	:	US
Telephone Number	:	219-947-1795
Fax Number	:

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	01/02/2015

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