Healthcare Provider Details

I. General information

NPI: 1427279348
Provider Name (Legal Business Name): ANDREW FISHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD
WINFIELD IL
60190-1295
US

IV. Provider business mailing address

25 N WINFIELD RD
WINFIELD IL
60190-1295
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4056
  • Fax: 630-933-4057
Mailing address:
  • Phone: 630-933-4056
  • Fax: 630-933-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036-118070
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number036118070
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: