Healthcare Provider Details

I. General information

NPI: 1073870366
Provider Name (Legal Business Name): MARK A FISCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S MAIN ST
SYCAMORE IL
60178-2229
US

IV. Provider business mailing address

404 S MAIN ST
SYCAMORE IL
60178-2229
US

V. Phone/Fax

Practice location:
  • Phone: 815-899-7084
  • Fax:
Mailing address:
  • Phone: 815-899-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.092628
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: