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NPI Code Detail

MEDICARE: MICHAEL R FISHER MD

MEDICARE: MICHAEL R FISHER MD
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
1174400000XSpecialist7224AWY
2208000000XPediatrics Physician7224AWY

General Provider Information

NPI Number : 1053311506
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL R FISHER MD
Provider Business Mailing Address
First Line : 1005 COLLEGE VIEW DR
Second Line :
City : RIVERTON
State : WY
Zip : 82501-2266
Country : US
Telephone Number : 307-857-5247
Fax Number : 307-857-5215
Provider Business Practice Location Address
First Line : 1005 COLLEGE VIEW DR
Second Line :
City : RIVERTON
State : WY
Zip : 82501-2266
Country : US
Telephone Number : 307-857-5247
Fax Number : 307-857-5215
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2005
Last Update Date : 02/25/2013

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