Individual
DR. MICHAEL ALAN FISHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10 N CUMBERLAND AVE, PARK RIDGE, IL 60068-3215
(847) 825-0300
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036090789
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036090789
—
IL
01
—
1634494
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/18/2005
Last updated
10/11/2023
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