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Contact Information

SAM FULLER, MD
53880 CARMICHAEL DR
SOUTH BEND, IN46635-1567
 Phone: 574-247-9441
 Fax: 574-247-9442
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Plastic and Reconstructive Surgery

2086S0122X 02 Physician/General Surgery
 

Surgery of the Hand

2086S0105X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for SAM FULLER · (Male)

NPI # 1649569484
Status Active
Credentials MD
Entity Individual
Enumeration date 04/01/2011
Last updated 09/03/2024 - More than a year ago
Sole proprietor 1 No
Identifiers
  • IN License # 01075560A
Hospital affiliation(s)
  • SAINT JOSEPH REGIONAL MEDICAL CENTER - (Acute Care)
    5215 HOLY CROSS PKWY
    MISHAWAKA, IN 46545
  • SAINT JOSEPH'S REGIONAL MEDICAL CENTER - PLYMOUTH - (Acute Care)
    1915 LAKE AVE
    PLYMOUTH, IN 46563
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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