Healthcare Provider Details

I. General information

NPI: 1184128670
Provider Name (Legal Business Name): SONYA JOY INDERBITZIN-FISCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 FOREMOST DR SE STE 200
GRAND RAPIDS MI
49546-7062
US

IV. Provider business mailing address

5800 FOREMOST DR SE STE 200
GRAND RAPIDS MI
49546-7062
US

V. Phone/Fax

Practice location:
  • Phone: 163-891-8006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number4301511732
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: