Ty Fullmer, DO
Emergency Medicine in Clinton Township, MI. Individual provider (NPI-1).
NPI number1679136758
StatusActive
Last updated in NPPESMay 19, 2022
Details
- NPI
- 1679136758
- Entity type
- Individual (NPI-1)
- Name
- Ty Fullmer
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 15, 2019
- Certification date
- May 19, 2022
- Last updated
- May 19, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207P00000X | Emergency Medicine | 12811005-1204 | UT | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
15855 19 Mile RdClinton Township, MI 48038-3504
Phone 586-263-2300
Mailing address
15855 19 Mile RdClinton Township, MI 48038-3504
Other practice locations
4401 Harrison Blvd
Ogden, UT 84403-3195
Ogden, UT 84403-3195
Phone 801-387-7000
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All 59 Emergency Medicine Physician providers in Clinton Township · All 3,035 providers in Clinton Township
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