Individual provider Active NPI

Nikolaus Christian Fulbright, M.D.

  • Family Medicine Physician
  • Sterling Heights, MI
National Provider Identifier
1235426966
Registry record updated Jul 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301098657 Issued in MI
Practice address
44250 Dequindre Rd
Sterling Heights, MI 48314-1002
Phone
(248) 964-0430
NPI assigned
Jul 1, 2011
Last updated
Jul 1, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301098657 MI Primary

Addresses

Primary practice location

44250 Dequindre Rd
Sterling Heights, MI 48314-1002

Mailing address

4411 Robinwood Ave
Royal Oak, MI 48073-1532
Phone (810) 300-8788

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140714001773 MI Practitioner - Family Practice 0547491862 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone (248) 424-3000

16001 W 9 Mile Rd 3Rd FL
Providence Hospital Gastrology
Southfield, MI 48075-4818
Phone (248) 849-6033

16001 W 9 Mile Rd 3Rd Floor
Providence Hospital Gastrology
Southfield, MI 48075-4818
Phone (248) 849-6033

210 N Lafayette St
South Lyon, MI 48178-2048

22250 Providence Dr
FL 5
Southfield, MI 48075-4825
Phone (248) 849-3441

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301098657MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health Providence Hospital CurrentSince Aug 1, 2014 Accepting new patients
Henry Ford Health Providence Hospital Family Medicine CurrentSince Aug 1, 2014 Accepting new patients
Henry Ford Health Providence Hospital Current Accepting new patients
Henry Ford Health Providence Hospital Past Accepting new patients

Locations

210 N Lafayette St
South Lyon, MI 48178
Phone (248) 437-1744

22250 Providence Dr
Fl 5
Southfield, MI 48075
Phone (248) 849-3441

28000 Dequindre Rd
Warren, MI 48092
Phone (586) 743-0944

Interoperability endpoints

  • Direct secure messaging: nfulbright1127352@direct.hfhs.org
  • Direct secure messaging: nikolaus.fulbright.1@16555.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309478400000",
    "number": "1235426966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 ROBINWOOD AVE",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480731532",
            "telephone_number": "810-300-8788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44250 DEQUINDRE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141002",
            "telephone_number": "248-964-0430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULBRIGHT",
        "first_name": "NIKOLAUS",
        "middle_name": "CHRISTIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-01",
        "last_updated": "2011-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301098657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling Heights, MI

Sources for this page

Verify at the official NPI Registry.