Individual
MISS MELISSA FISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2900 FOXFIELD RD, ST CHARLES, IL 60174-5799
(630) 377-7900
(630) 377-8007
Mailing address
2900 FOXFIELD RD, ST CHARLES, IL 60174-5799
(630) 377-7900
(630) 377-8007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-134529
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920540
MEDICARE GROUP
IL
01
—
CA4748
MEDICARE RAILROAD (GROUP)
IL
01
—
F400150549
MEDICARE INDIVIDUAL
IL
01
—
P01387861
MEDICARE RAILROAD
IL
Enumeration date
06/01/2011
Last updated
01/16/2015
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