National Provider Identifier Database

SAM FULLER, MD – NPI #1649569484
Plastic and Reconstructive Surgery


Contact Information

SAM FULLER, MD
53880 CARMICHAEL DR
SOUTH BEND, IN46635-1567
Phone: 574-247-9441
Fax: 574-247-9442
Website:
Specialty Taxonomy Code
* Plastic and Reconstructive Surgery 2086S0122X
Surgery of the Hand 2086S0105X

* Indicates primary specialty

NPI Profile & details for SAM FULLER

NPI Number 1649569484
Credentials MD
Entity Individual
Enumeration date 04/01/2011
Last updated 09/03/2024 - More than a year ago
Sole proprietor1 No
Identifiers
  • IN License #: 01075560A
Hospital affiliation n/a

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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