Healthcare Provider Details

I. General information

NPI: 1174631188
Provider Name (Legal Business Name): JAMES S FISTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36W431 HUNTERS GATE RD
SAINT CHARLES IL
60175-5129
US

IV. Provider business mailing address

36W431 HUNTERS GATE RD
SAINT CHARLES IL
60175-5129
US

V. Phone/Fax

Practice location:
  • Phone: 630-584-7397
  • Fax:
Mailing address:
  • Phone: 630-584-7397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036059573
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number036059573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: