Healthcare Provider Details

I. General information

NPI: 1730456914
Provider Name (Legal Business Name): JUSTIN LEE FISCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JUSTIN LEE FISCHER MD

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST STE 300
PEORIA IL
61606-2036
US

IV. Provider business mailing address

1001 MAIN ST STE 300
PEORIA IL
61606-2036
US

V. Phone/Fax

Practice location:
  • Phone: 309-495-0201
  • Fax: 309-676-6545
Mailing address:
  • Phone: 309-495-0201
  • Fax: 309-676-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number036139889
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: