Healthcare Provider Details

I. General information

NPI: 1841966132
Provider Name (Legal Business Name): MARTIKA FISHER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N MAIN ST STE 321
ENGLEWOOD OH
45415-1185
US

IV. Provider business mailing address

9000 N MAIN ST STE 321
ENGLEWOOD OH
45415-1185
US

V. Phone/Fax

Practice location:
  • Phone: 937-836-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: