Healthcare Provider Details

I. General information

NPI: 1255314365
Provider Name (Legal Business Name): CHARLES MICHAEL FISCHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 37TH PL FL 2
VERO BEACH FL
32960-4508
US

IV. Provider business mailing address

PO BOX 38
VERO BEACH FL
32961-0038
US

V. Phone/Fax

Practice location:
  • Phone: 772-794-2222
  • Fax: 772-794-0045
Mailing address:
  • Phone: 772-539-1775
  • Fax: 772-569-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberME25700
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME25700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: