Healthcare Provider Details

I. General information

NPI: 1558645200
Provider Name (Legal Business Name): MICHAEL FLEISCHMAN CBPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 KELP AVE
FAIRFIELD IA
52556-9018
US

IV. Provider business mailing address

1938 KELP AVE
FAIRFIELD IA
52556-9018
US

V. Phone/Fax

Practice location:
  • Phone: 641-472-7741
  • Fax:
Mailing address:
  • Phone: 641-472-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number03213
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: