Healthcare Provider Details

I. General information

NPI: 1780037135
Provider Name (Legal Business Name): STEPHANIE ANNE FISHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 14-200
CHICAGO IL
60611-5966
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 14-200
CHICAGO IL
60611-5966
US

V. Phone/Fax

Practice location:
  • Phone: 312-472-4685
  • Fax: 312-472-4687
Mailing address:
  • Phone: 312-472-4685
  • Fax: 312-472-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036151929
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number036151929
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: