1841214061 NPI number — ROBERT H FISHER M.D.

Table of content: ROBERT H FISHER M.D. (NPI 1841214061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841214061 NPI number — ROBERT H FISHER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHER
Provider First Name:
ROBERT
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1841214061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350W GREEN TREE RD 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53217-3815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-352-0084
Provider Business Mailing Address Fax Number:
414-352-0083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 W GREEN TREE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-784-5431
Provider Business Practice Location Address Fax Number:
414-352-0083
Provider Enumeration Date:
07/27/2006

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: 207RA0201X , with the licence number:  34325-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 34325-020 , 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: 0557326 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3920328241071690 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00308927 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 31925700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 392032824 . This is a "WEA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4638942 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".