Kathleen M Fulgenzi, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301042670 Issued in MI

Practice address

24911 Little Mack Ave
St Clair Shores, MI 48080-3200

Phone

(586) 777-2050

Fax

(586) 777-2189

NPI assigned

Aug 19, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Seton Health Corporation of Southeastern Michigan

  • Family Medicine Physician
  • Clinton Township, MI
  • NPI 1598177065
  Medicare reassignment NPD
• Seton Health Corporation of Southeastern Michigan

  • Physical Therapy Clinic/Center
  • Macomb, MI
  • NPI 1487067260
  NPD

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392681600000",
    "number": "1588656102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43800 GARFIELD RD",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480381136",
            "telephone_number": "586-777-2050",
            "fax_number": "586-777-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24911 LITTLE MACK AVE",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "480803200",
            "telephone_number": "586-777-2050",
            "fax_number": "586-777-2189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULGENZI",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-19",
        "last_updated": "2014-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301042670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4420765",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0Q262160",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corinne Elizabeth Frontiero
• Regina Frost, M.D.
• Adam Craig Fry
• Michael Thomas Fry, MD
• Gina Marie Fuga, DC
• Janice M Fuller
• Halee Fustini
• G. Dino Tolias,D.D.S. P.C.
• Carissa Laura Gaden, PH.D.
• Santana Gaines

• Family Medicine Physician in St Clair Shores, MI
• Providers in St Clair Shores, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.