Healthcare Provider Details

I. General information

NPI: 1003906819
Provider Name (Legal Business Name): FISCHMAN & BORGMEIER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 36TH STREET STE C
VERO BEACH FL
38960
US

IV. Provider business mailing address

1600 36TH STREET STE C
VERO BEACH FL
38960
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-6112
  • Fax: 772-569-5058
Mailing address:
  • Phone: 772-569-6112
  • Fax: 772-569-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME25700
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0089867
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME62133
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME44223
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA91103803
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME25700
License Number StateFL

VIII. Authorized Official

Name: MRS. CAROL A FISCHMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 772-569-6114