MEDICARE: DR. MICHAEL ANTHONY FISHER M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0800X	Psychiatry Physician	53500	AZ

General Provider Information

NPI Number	:	1679986137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANTHONY FISHER M.D.

Provider Business Mailing Address
First Line	:	2601 E. ROOSEVELT ST.
Second Line	:	MARICOPA INTEGRATED HEALTH SYSTEM
City	:	PHOENIX
State	:	AZ
Zip	:	85008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16448 E GLENBROOK BLVD
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-2243
Country	:	US
Telephone Number	:	516-205-4489
Fax Number	:

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

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	09/04/2019

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