BRENT FULLER (NPI# 1871552646) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871552646 |
| Entity Type | Individual |
| Full Name | BRENT FULLER |
| Practice Address |
8545 Common Rd Suite 200 Warren MI 48093-6772 |
| Practice Telephone | 5867510732 |
| Practice Fax Number | 5867513822 |
| Mailing Telephone | 5867510732 |
| Mailing Fax Number | 5867513822 |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2010-03-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 4301070157 | MI | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 4301070157 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBSM | 110F376980 | 01 |
| MI | 4800002 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902335979 | Brent Fuller | Physical Therapist | 7231 Sunwood Dr Nw, Ramsey, MN 55303-5190 | 2017-06-05 |
| Street Address |
8545 COMMON RD SUITE 200 |
| City | WARREN |
| State | MI |
| Zip Code | 48093-6772 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306346945 | Christina Tironi | Physical Therapist | 8545 Common Rd, Warren, MI 48093-6772 | 2018-02-20 |
| 1548687312 | Jessica Lopiccolo | Nurse Practitioner | 8545 Common Rd, Suite 200, Warren, MI 48093-6772 | 2014-03-18 |
| 1194930891 | Jeffrey Fisher | Internal Medicine | 8545 Common Rd, # 200, Warren, MI 48093-6772 | 2007-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023615986 | Toleka Regina Taylor | Nurse Anesthetist, Certified Registered | St. John Macomb Hospital, 11800 East 12 Mile Road, Warren, MI 48093 | 2020-10-05 |
| 1679112676 | Open Heart Communities | Case Management | 31310 Shaw Dr, Warren, MI 48093 | 2019-12-23 |
| 1538715636 | 3 Dove Medical Supplies | Durable Medical Equipment & Medical Supplies | 31201 Chicago Rd S Ste C101, Warren, MI 48093 | 2019-08-14 |
| 1568954600 | Schreiber Cardiology, P.C. | Internal Medicine | 8545 Common Rd Ste 150, Warren, MI 48093 | 2018-06-05 |
| 1730686197 | Lambro Seremetis | Social Worker | 12200 E. 12 Mile Road, Ste. 200, Warren, MI 48093 | 2018-04-11 |
| 1649775826 | Ridge Downs | Behavioral Analyst | 31201 Chicago Rd South, Suite C- 202, Warren, MI 48093 | 2018-03-28 |
| 1144722737 | Jessica Farraj | Occupational Therapist | 11800 E. 12 Mile Road, Warren, MI 48093 | 2018-02-28 |
| 1265930168 | Leah Hanrahan | Registered Nurse | 11700 Amberle Dr., Warren, MI 48093 | 2018-01-25 |
| 1598271553 | Pamela Marie Confer | Occupational Therapist | 11012 13 Mile Rd, Suite 200, Warren, MI 48093 | 2017-12-28 |
| 1831604347 | Kate Jeanne Szczepanski | Behavior Technician | 31200 Chicago Rd S, Warren, MI 48093 | 2017-12-06 |
| Find all providers in zip 48093 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316347917 | Gerald F Daneshvar Md Pllc | Internal Medicine | 13201 Stephens Rd Ste F, Warren, MI 48089-4340 | 2014-09-02 |
| 1831509413 | Chandana Pande | Internal Medicine | 34 Moutain Blvd, Warren, NJ 07059 | 2014-05-05 |
| 1457798829 | Manuela Belda Hamaoui | Internal Medicine | 34 Mountain Blvd Bldg C, Warren, NJ 07059-2640 | 2013-05-26 |
| 1124464268 | Kelli Lynne Virgin | Internal Medicine | 11855 E 12 Mile Rd Ste 400, Warren, MI 48093-3471 | 2013-05-16 |
| 1780029074 | Ez Rest Re-hab Center Inc. | Internal Medicine | 25932 Dequindre Rd Ste C, Warren, MI 48091-1071 | 2013-05-01 |
| 1043516636 | Paolo Augusto Salvatore | Internal Medicine | 28 Helen St, Warren, NJ 07059-5817 | 2011-01-31 |
| 1861710154 | Heather Lynn Franke | Internal Medicine | 11885 E 12 Mile Rd Ste 300a, Warren, MI 48093-3467 | 2010-05-11 |
| 1437399326 | Charles Hammond Mcgowen | Internal Medicine | 90 Oak Tree Ln Se, Warren, OH 44484-5611 | 2009-03-05 |
| 1710151782 | Richard M Liss | Internal Medicine | 6 Debby Ln, Warren, NJ 07059-5013 | 2008-04-21 |
| 1679751564 | Hoover Medical Clinic PC | Internal Medicine | 31690 Hoover, Warren, MI 48093 | 2008-02-04 |
| Find all providers in WARREN | ||||
Please comment or provide details below to improve the information on BRENT FULLER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.