Healthcare Provider Details

I. General information

NPI: 1629399985
Provider Name (Legal Business Name): MICHELLE FISHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLORIDA ENT & ALLERGY 13015 SUMMERFIELD SQUARE DR
RIVERVIEW FL
33578-7402
US

IV. Provider business mailing address

SELECT PHYSICIANS ALLIANCE 10002 PRINCESS PALM AVE. STE 332
TAMPA FL
33619-8327
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-8045
  • Fax: 855-388-5356
Mailing address:
  • Phone: 813-571-7184
  • Fax: 813-654-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125-058029
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME125928
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4854
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: