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NPI Code Detail

MEDICARE: CORY M FISHER DO

MEDICARE:   CORY M FISHER  DO
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
1207Q00000XFamily Medicine Physician34.008679OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000526275OTHERANTHEM BC/BS
200000526262OTHERANTHEM BC/BS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4P00441657OTHEROHRRCARE
5P00705928OTHEROHRAILROAD CARE

General Provider Information

NPI Number : 1730304304
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORY M FISHER DO
Provider Business Mailing Address
First Line : 19324 DETROIT RD
Second Line :
City : ROCKY RIVER
State : OH
Zip : 44116-1802
Country : US
Telephone Number : 440-356-3640
Fax Number : 440-356-3729
Provider Business Practice Location Address
First Line : 19324 DETROIT RD
Second Line :
City : ROCKY RIVER
State : OH
Zip : 44116-1802
Country : US
Telephone Number : 440-356-3640
Fax Number : 440-356-3729
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 06/26/2009

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Directions to “ CORY M FISHER DO” Practice Location

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