Healthcare Provider Details

I. General information

NPI: 1114125697
Provider Name (Legal Business Name): FISCHER FOOT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N LOGAN AVE SUITE 104
DANVILLE IL
61832-3741
US

IV. Provider business mailing address

800 N LOGAN AVE SUITE 104
DANVILLE IL
61832-3741
US

V. Phone/Fax

Practice location:
  • Phone: 217-431-4280
  • Fax: 217-431-4834
Mailing address:
  • Phone: 217-431-4280
  • Fax: 217-431-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016004411
License Number StateIL

VIII. Authorized Official

Name: DR. DENISE M FISCHER
Title or Position: DOCTOR
Credential: DPM
Phone: 217-431-4280