Porter, Fulton
Porter, Fulton is an individual health care provider with primary practice located at 17850 Kedzie Ave 3200, Hazel Crest IL 60429-2058. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospitalist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Porter, Fulton can be contacted via phone (708) 798-8112.Contact Information
Primary practice address
17850 Kedzie Ave 3200
Hazel Crest IL 60429-2058
Phone: (708) 798-8112
Fax: (708) 798-9016
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 01071861A | Indiana |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 036101229 | Illinois |
Profile Details
| NPI number | 1316944341 |
|---|---|
| LBN Legal business name | Porter, Fulton |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 5th, 2005 |
| Last updated | Dec 12th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316944341 | NPPES |
| Illinois | MEDICAID | 036101229 | |
| Illinois | Other | P00439469/CK6882 |
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