Healthcare Provider Details

I. General information

NPI: 1629069737
Provider Name (Legal Business Name): DONALD C FISCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W MAIN ST STE 350
PORT WASHINGTON WI
53074-1813
US

IV. Provider business mailing address

108 E NORTH ST
FRIENDSHIP WI
53934-9443
US

V. Phone/Fax

Practice location:
  • Phone: 262-284-8130
  • Fax: 262-284-8104
Mailing address:
  • Phone: 608-339-4505
  • Fax: 608-339-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22356020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: