MEDICARE: JAMES FISHER III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1003268822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES FISHER III

Provider Business Mailing Address
First Line	:	25014 CURRIER ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1877
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25014 CURRIER ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1877
Country	:	US
Telephone Number	:	724-734-0834
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	07/05/2016

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