# MODERN OBSTETRICS & GYNECOLOGY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205002342
- **Authorized official:** JAY E FISHER MD (PHYSICIAN/ PRESIDENT)
- **Authorized official phone:** (248) 862-7221

## Contact information

- **Practice address:** 5793 W MAPLE RD STE 147, WEST BLOOMFIELD, MI 48322-4478
- **Practice address phone:** (248) 862-7221
- **Practice address fax:** (248) 970-2941
- **Mailing address:** 5793 W MAPLE RD STE 147, WEST BLOOMFIELD, MI 48322-4478
- **Mailing address phone:** (248) 862-7221
- **Mailing address fax:** (248) 970-2941

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/07/2008
- **Last updated:** 02/04/2019