Healthcare Provider Details

I. General information

NPI: 1841214061
Provider Name (Legal Business Name): ROBERT H FISHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W GREEN TREE RD
GLENDALE WI
53217
US

IV. Provider business mailing address

350W GREEN TREE RD 200
GLENDALE WI
53217-3815
US

V. Phone/Fax

Practice location:
  • Phone: 262-784-5431
  • Fax: 414-352-0083
Mailing address:
  • Phone: 414-352-0084
  • Fax: 414-352-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number34325-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34325-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: