1629069737 NPI number — DONALD C FISCHER MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629069737 NPI number — DONALD C FISCHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISCHER
Provider First Name:
DONALD
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629069737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 E NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIENDSHIP
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53934-9443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-339-4505
Provider Business Mailing Address Fax Number:
608-339-4593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 W MAIN ST
Provider Second Line Business Practice Location Address:
STE 350
Provider Business Practice Location Address City Name:
PORT WASHINGTON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53074-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-284-8130
Provider Business Practice Location Address Fax Number:
262-284-8104
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  22356020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31980600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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