Individual
FREDERICK S FISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 OSBORNE RD NE STE 330, FRIDLEY, MN 55432-2769
(763) 571-4000
(763) 502-2966
Mailing address
119 14TH ST NW STE 240, NEW BRIGHTON, MN 55112-0007
(763) 571-4000
(763) 502-2966
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
26385
MN
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
26385
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
394783100
—
MN
Enumeration date
06/10/2006
Last updated
08/22/2022
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