Healthcare Provider Details

I. General information

NPI: 1831459635
Provider Name (Legal Business Name): MICHAEL PAUL FISCHER MS, RD, LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PARK NICOLLET BLVD.
ST. LOUIS PARK MN
55416-2527
US

IV. Provider business mailing address

8170 33RD AVE S MAIL STOP 21110Q
MINNEAPOLIS MN
55440-1309
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL003826
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: