Healthcare Provider Details

I. General information

NPI: 1811248917
Provider Name (Legal Business Name): MICHAEL C FISHER C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N HILLSIDE ST SUITE C
WICHITA KS
67214-4915
US

IV. Provider business mailing address

824 E 6TH ST
NEWTON KS
67114-3026
US

V. Phone/Fax

Practice location:
  • Phone: 316-993-6391
  • Fax:
Mailing address:
  • Phone: 316-993-6391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: