IndividualActive
John Fulling, IDC
NPI 1083873905 · Independent Duty Corpsman · Great Lakes, IL
Provider details
- NPI number
- 1083873905
- Entity type
- Individual
- Primary specialty
- Independent Duty CorpsmanOther Service Providers
- Credential
- IDC
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Other Service Providers
Practice location
2410 Sampson St
Fisher Bmc #237
Great Lakes, IL 60088
Phone: (847) 688-5556
Fax: (847) 688-2512
Approximate (ZIP-level) locationGet directions
Mailing address
2524 N Poplar St
Waukegan, IL 60087-3127
Registry dates
- Enumerated
- 2008-06-05
- Last updated
- 2008-06-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.