Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Tanner Michael Fullmer

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1285028753

Mr. Tanner Michael Fullmer is an Otolaryngology in Milwaukee, Wisconsin. Graduated from Medical College of Wisconsin in 2015, 11 years ago. Practices with Columbia St Marys Hospital Milwaukee Inc, a 314-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
11
Trained at
Medical College of Wisconsin
Licensed in
WI
In the registry since
2015
Specialties on file
2
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Practice location Address checks out

2311 N Prospect Ave
Milwaukee, WI 53211-4445
Phone: (414) 319-3000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Otolaryngology Physician (primary) Taxonomy 207Y00000X · Licence 74914 (WI)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1285028753
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 23, 2015
Last updated in NPPESJune 18, 2021
Certification dateJune 18, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOTOLARYNGOLOGY
Medical schoolMEDICAL COLLEGE OF WISCONSIN
Graduated 2015 (11 years in practice)
Group practice Columbia St Marys Hospital Milwaukee Inc — 314 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Milwaukee