Healthcare Provider Details

I. General information

NPI: 1992728539
Provider Name (Legal Business Name): WILLIAM J FISHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 ARBOR LN STE D
NEW PALESTINE IN
46163-9269
US

IV. Provider business mailing address

4037 ARBOR LN STE D
NEW PALESTINE IN
46163-9269
US

V. Phone/Fax

Practice location:
  • Phone: 317-861-7125
  • Fax: 317-861-7141
Mailing address:
  • Phone: 317-861-7125
  • Fax: 317-861-7141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01055043A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: