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Contact Information

TANNER M FULLMER
2311 N PROSPECT AVE
MILWAUKEE, WI53211-4445
 Phone: 414-319-3000
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for TANNER M FULLMER · (Male)

NPI # 1285028753
Status Active
Credentials
Entity Individual
Enumeration date 03/23/2015
Last updated 06/18/2021 - About 5 years ago
Sole proprietor 1 Yes
Identifiers
  • WI License # 74914
Hospital affiliation(s)
  • COLUMBIA ST MARY'S HOSPITAL MILWAUKEE - (Acute Care)
    2323 N LAKE DR
    MILWAUKEE, WI 53211
  • COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC - (Acute Care)
    13111 N PORT WASHINGTON RD
    MEQUON, WI 53097
  • WHEATON FRANCISCAN INC- ST JOSEPH - (Acute Care)
    5000 W CHAMBERS ST
    MILWAUKEE, WI 53210
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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