Individual
THOMAS J FISCHBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 NAVARRE PL STE 5500, SOUTH BEND, IN 46601-1172
(574) 647-5200
(574) 647-5210
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01043728
IN
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01043728A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200041710
—
IN
Enumeration date
09/12/2005
Last updated
03/30/2021
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