Healthcare Provider Details

I. General information

NPI: 1174704985
Provider Name (Legal Business Name): CAROL M FISCHER DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 HARRINGTON ST SUITE 201
MOUNT CLEMENS MI
48043-2967
US

IV. Provider business mailing address

1030 HARRINGTON ST SUITE 201
MOUNT CLEMENS MI
48043-2967
US

V. Phone/Fax

Practice location:
  • Phone: 586-493-3880
  • Fax: 586-493-3883
Mailing address:
  • Phone: 586-493-3880
  • Fax: 586-493-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number5101015319
License Number StateMI

VIII. Authorized Official

Name: KIM MARIE GRALESKI
Title or Position: BILLER/ OFFICE MANAGER
Credential:
Phone: 586-493-3880