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Individual

ANDREW FISHMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-4056
(630) 933-4057
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-4056
(630) 933-4057

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
036-118070
IL
207YX0901X
Otology & Neurotology Physician
Primary
036118070
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036118070
IL
01
206147221
MEDICARE (INDIVIDUAL PTAN)
IL
01
CE8792
MEDICARE RAILROAD PTAN (GROUP)
IL
01
P01185371
MEDICARE RAILROAD PTAN (INDIVIDUAL)
IL
Enumeration date
05/01/2007
Last updated
11/11/2013
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