Individual
DR. THEODORE D. FIFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D. FACS
Contact information
Practice address
14900 N COURT 9, EFFINGHAM, IL 62401-7640
(217) 994-6162
(217) 342-7094
Mailing address
14900 N COURT 9, EFFINGHAM, IL 62401-7640
(217) 994-6162
(217) 342-7094
Taxonomy
Speciality
Code
Description
License number
State
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
036084136
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
036084136
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025-00076
BLUE CROSS
IL
05
—
036-084136
—
IL
Enumeration date
02/13/2008
Last updated
12/12/2012
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