DOUGLAS R FULLEN (NPI# 1730260183) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730260183 |
| Entity Type | Individual |
| Full Name | DOUGLAS R FULLEN |
| Credential | MD |
| Practice Address |
1500 E Medical Center Dr Ann Arbor MI 48109-5000 |
| Mailing Address |
3621 S State St Ann Arbor MI 48108-1633 |
| Practice Telephone | 7349364000 |
| Mailing Telephone | 7346475299 |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-10-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZD0900X |
Pathology Specialization: Dermatopathology |
4301063830 | MI | Allopathic & Osteopathic Physicians |
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
4301063830 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 4230027 | 05 |
| Street Address |
1500 E MEDICAL CENTER DR |
| City | ANN ARBOR |
| State | MI |
| Zip Code | 48109-5000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669475836 | Tami L. Remington | Pharmacist | 1500 E Medical Center Dr, Ann Arbor, MI 48109-0999 | 2005-05-23 |
| 1578164810 | Jessica Leigh Bailey | Nurse Practitioner | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2020-11-03 |
| 1518565910 | Yoshiaki Ota | Student in an Organized Health Care Education/Training Program | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2020-10-16 |
| 1366058356 | Paulo Zupelari Goncalves | Dentist | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2020-09-16 |
| 1306459466 | Jesse P Spalding | Nurse Practitioner | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2020-08-28 |
| 1992318919 | Batoul Berri | Audiologist | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2020-08-28 |
| 1063024891 | Nathan Allen Johnson | Nurse Practitioner | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2020-08-22 |
| 1780296699 | Yoav Hammer | Internal Medicine | 1500 E Medical Center Dr, 2nd Floor, Cardiovascular Center, Ann Arbor, MI 48109-5853 | 2020-08-21 |
| 1891306262 | Sarah Garnai | Student in an Organized Health Care Education/Training Program | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2020-08-11 |
| 1386254936 | Ryan James Sutherlan | Pharmacist | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2020-08-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558987024 | Albert Byun | Student in an Organized Health Care Education/Training Program | 1500 E.medical Center Dr., 1h247, Ann Arbor, MI 48109 | 2020-06-22 |
| 1851914931 | Nadine Ibrahim | Student in an Organized Health Care Education/Training Program | 1500 E. Medical Center Drive, Spc 5312, Taubman Center, 1st Floor, Room 1903, Ann Arbor, MI 48109 | 2020-05-22 |
| 1568083350 | Tucker Zimmer | Student in an Organized Health Care Education/Training Program | 1500 E Medical Center Dr, Uh South F-6245, Ann Arbor, MI 48109 | 2020-05-03 |
| 1144841099 | Jessica Moore Meves | Student in an Organized Health Care Education/Training Program | 1500 E Medical Center Drive, Uh South F-6245, Ann Arbor, MI 48109 | 2020-05-01 |
| 1710522297 | Xiaoyuan Hu | Specialist/Technologist | Obl 2150, 1402 Washington Hts, Ann Arbor, MI 48109 | 2019-11-08 |
| 1376192401 | Regina Kay Freeman | Clinical Nurse Specialist | 4726 Cardiovascular Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109 | 2019-09-11 |
| 1477114155 | William Philip Saunders IIi | Student in an Organized Health Care Education/Training Program | 300 N Ingalls Building, Rm Ni4co6, Ann Arbor, MI 48109 | 2019-06-24 |
| 1093290447 | Teresa H Lyden | Speech-Language Pathologist | 1500 E. Medical Center Dr., Spc 5312, 1904 Tc, Otolaryngology-head and Neck Surgery, Ann Arbor, MI 48109 | 2018-10-02 |
| 1649755091 | Anna Grace Hardenbergh | Speech-Language Pathologist | 1500 E. Medical Center Drive Tc 1904, Otolaryngology Head and Neck Surgery, Ann Arbor, MI 48109 | 2018-10-02 |
| 1548754609 | Amy Wu | Pediatrics | 1500 East Medical Center Drive., Medical Professional Bldg. D-3238, Ann Arbor, MI 48109 | 2018-06-21 |
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| Taxonomy Code | 207ZD0900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Dermatopathology |
| A dermatopathologist is an expert in diagnosing and monitoring diseases of the skin including infectious, immunologic, degenerative, and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings, and smears of skin lesions by means of light microscopy, electron microscopy, and fluorescence microscopy. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source added] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. A subspecialty certificate was first issued by the ABMS in 1974. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770804312 | David Phillip Arps | Pathology | 1500 E Medical Center Drive, 2nd Floor University Hospital Recp Pathology, Ann Arbor, MI 48109-5054 | 2010-06-17 |
| 1033351044 | Rajiv Michael Patel | Pathology | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2009-04-06 |
| 1508890468 | Regents of The University of Michigan | Pathology | 1500 East Medical Center Drive, 2nd Floor University Hospital Recp Pathology, Ann Arbor, MI 48109-5054 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457359945 | Jean E Thomas | Pathology | 1314 N Macomb St, Monroe, MI 48162-3131 | 2005-07-08 |
| 1861712994 | Joshua R Bradish | Pathology | 1521 Gull Rd, Kalamazoo, MI 49048-1640 | 2010-06-11 |
| 1720292493 | Michelle R Young | Pathology | 1105 Sixth St, Traverse City, MI 49684-2345 | 2007-05-10 |
| 1992828560 | Limin Yu | Pathology | 3601 W 13 Mile Rd, Royal Oak, MI 48073-6712 | 2007-04-09 |
| 1477601185 | Min W. Lee | Pathology | Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202 | 2007-01-08 |
| 1457419160 | Mary Beth Anderson | Pathology | 18756 Millar Rd, Clinton Township, MI 48036-2095 | 2006-12-05 |
| 1326120023 | Kimberley Gretchen Behrens | Pathology | 6330 Orchard Lake Rd, Suite 120, West Bloomfield, MI 48322-2398 | 2006-10-20 |
| 1740397124 | Kent Pathology Laboratory Pllc | Pathology | 2650 Horizon Dr Se, Suite B, Grand Rapids, MI 49546-7519 | 2006-08-23 |
| 1306952742 | Earl Thomas Hawkins | Pathology | 22101 Moross Rd, Sjhmc Department of Pathology, Detroit, MI 48236-2148 | 2006-08-21 |
| 1962447219 | Albert Kayoon Kim | Pathology | 2650 Horizon Dr Se, Suite B, Grand Rapids, MI 49546-7519 | 2006-06-19 |
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| 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.