Healthcare Provider Details

I. General information

NPI: 1386750115
Provider Name (Legal Business Name): PETER M FISCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 ONTARIO RD
GREEN BAY WI
54311-8302
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 920-983-9633
  • Fax:
Mailing address:
  • Phone: 414-423-4100
  • Fax: 414-423-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37609
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01040474A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: