Healthcare Provider Details

I. General information

NPI: 1942292610
Provider Name (Legal Business Name): ROBERT N. FISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 PORT WASHINGTON RD
GRAFTON WI
53024-9201
US

IV. Provider business mailing address

975 PORT WASHINGTON RD
GRAFTON WI
53024-9201
US

V. Phone/Fax

Practice location:
  • Phone: 262-329-1000
  • Fax: 262-329-1001
Mailing address:
  • Phone: 262-329-1000
  • Fax: 262-329-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number55659-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2010-00086
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: