NPI 1023574787

Kenneth Fultz, CPRM

Practitioner Peer Specialist Detroit, MI

Practice location

Address: 15941 Fairfield St, Detroit, MI 48238-4123
Phone: (313) 345-4310
Fax: (313) 345-4315

Registered specialties

Peer Specialist Primary

Other Service Providers Taxonomy 175T00000X

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Registry record

NPI: 1023574787
Entity type: Individual
Sex (as registered): Male
NPI issued: 18 Feb 2019
Record last updated: 18 Feb 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.