Individual
DWIGHT FISKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, RN, AEMT
Contact information
Practice address
200 HEMLOCK ST, TAWAS CITY, MI 48763-9237
(989) 362-3411
(989) 362-9925
Mailing address
902 W 1ST ST, TAWAS CITY, MI 48763-9688
(989) 820-8127
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003088
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01147225
AMERIGROUP
GA
05
—
542502590A
—
GA
05
—
542502590B
—
GA
Enumeration date
07/17/2006
Last updated
07/21/2022
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