Provider Demographics
NPI:1023345956
Name:FULKERT, KARL ANDREW (DPM)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:ANDREW
Last Name:FULKERT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 E WILSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2354
Mailing Address - Country:US
Mailing Address - Phone:614-885-8895
Mailing Address - Fax:614-785-6543
Practice Address - Street 1:37 E WILSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2354
Practice Address - Country:US
Practice Address - Phone:614-885-8895
Practice Address - Fax:614-785-6543
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001099A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
508770FMedicare PIN
IN0430490001Medicare NSC