EDWARD STEVEN FULLER (NPI# 1932257672) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932257672 |
| Entity Type | Individual |
| Full Name | EDWARD STEVEN FULLER |
| Credential | PA-C |
| Practice Address |
22101 Moross Road Detroit MI 48236-2172 |
| Mailing Address |
5041 Yankee St. Clair MI 48079 |
| Practice Telephone | 3133436866 |
| Mailing Telephone | 8103296435 |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
5601002984 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457454548 | Edward P Fuller | Pathology | 101 Civic Center Lane, Lake Havasu City, AZ 86403 | 2006-09-06 |
| 1851321301 | Edward K Fuller | Anesthesiology | 25 Ridgewood Road, Springfield, VT 05156 | 2006-07-03 |
| Street Address |
22101 MOROSS ROAD |
| City | DETROIT |
| State | MI |
| Zip Code | 48236-2172 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558714436 | Michael Taylor II | Student in an Organized Health Care Education/Training Program | 22101 Moross Road, Detroit, MI 48236 | 2016-07-15 |
| 1316292204 | Sachith Chathuranga Wijekoon | Family Medicine | 22101 Moross Road, St John Hospital and Medical Center, Detroit, MI 48236 | 2012-07-17 |
| 1215138086 | Kevin Caesar Menes | Emergency Medicine | 22101 Moross Road, Department of Emergency Medicine, Detroit, MI 48236-2172 | 2007-05-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093323966 | Khairya Fatouh | Pathology | 22101 Morros Road, Pathology Department, Detroit, Detroit, MI 48236 | 2020-07-16 |
| 1134744998 | Harish Harry Gidda | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-08 |
| 1770107443 | Arshan Ali Khan | Internal Medicine | 22101 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-05-29 |
| 1750901658 | Annika Van Wieren | Emergency Medicine | 22101 Moross Road, Emergency Department, Detroit, MI 48236 | 2020-04-21 |
| 1801449483 | Ishaq Azeem Asghar | Student in an Organized Health Care Education/Training Program | 22101 Moross Road, Pathology Department, Detroit, MI 48236 | 2019-07-22 |
| 1295290443 | Ascension St. John Hospital | Dietitian, Registered | 22201 Moross, Ste. 270, Detriot, MI 48236 | 2019-02-01 |
| 1548747413 | Abiodun Adenuga Adefarasin | Pharmacist | 20746 Mack Avenue, Gross Pointe Woods, MI 48236 | 2018-07-24 |
| 1629564042 | Hamza H Khan | Student in an Organized Health Care Education/Training Program | 22201 Moross, Professional Building 2, Suite 70, Detroit, MI 48236 | 2018-07-09 |
| 1235631664 | David Lee Williams | Physical Therapist | 159 Kercheval Avenue, Grosse Pointe Farms, MI 48236 | 2018-03-01 |
| 1164979720 | Memphie Morgan | Licensed Practical Nurse | 91527 Cheshire St., Grosse Pointe, MI 48236 | 2016-09-01 |
| Find all providers in zip 48236 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700248176 | Katilyn Kohl | Physician Assistant | 3990 John R St Ste 4905, Detroit, MI 48201-2018 | 2016-03-24 |
| 1881822187 | Shea Mace | Physician Assistant | 6799 West Grand Blvd, Detroit, MI 48202 | 2009-06-24 |
| 1942469135 | Marcus Harris | Physician Assistant | 13949 Artesian St, Detroit, MI 48223-2915 | 2008-06-03 |
| 1316135379 | Clifford N Owhor | Physician Assistant | 4777 E Outer Dr Ste 1147, Detroit, MI 48234-3241 | 2007-10-04 |
| 1720513435 | Olivia Luisa Rojas | Physician Assistant | 2799 W Grand Blvd, Clinic K, 11th Floor, Detroit, MI 48202-2608 | 2017-05-01 |
| 1043760754 | Nicholas Joseph Michel | Physician Assistant | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2016-10-05 |
| 1013387174 | Sybrena Evans | Physician Assistant | 3901 Beaubien St, Detroit, MI 48201-2119 | 2015-10-01 |
| 1639574494 | Matthew Scott Mckay | Physician Assistant | 6071 W Outer Dr, Detroit, MI 48235-2624 | 2014-10-22 |
| 1922348184 | Carleta Poydras | Physician Assistant | 6071 W Outer Dr, Joint Excel Plus Orthopedic Clinic, Detroit, MI 48235-2624 | 2013-02-26 |
| 1801162532 | Jodi Iacco | Physician Assistant | 22201 Moross Rd, Professional Building 1 Suite 132, Detroit, MI 48236-2169 | 2012-03-27 |
| Find all providers in DETROIT | ||||
Please comment or provide details below to improve the information on EDWARD STEVEN 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.