Healthcare Provider Details

I. General information

NPI: 1225025893
Provider Name (Legal Business Name): WILLIAM FISHCO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41818 N VENTURE DR # D SUITE 110
ANTHEM AZ
85086-3188
US

IV. Provider business mailing address

41818 N VENTURE DR STE 110
PHOENIX AZ
85086-3189
US

V. Phone/Fax

Practice location:
  • Phone: 623-551-5000
  • Fax: 602-993-2705
Mailing address:
  • Phone: 623-551-5000
  • Fax: 623-551-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0486
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: