Healthcare Provider Details

I. General information

NPI: 1720074107
Provider Name (Legal Business Name): ERIC ROBERT FISHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 AMERICAN AVE
WAUKESHA WI
53188-5031
US

IV. Provider business mailing address

725 AMERICAN AVE
WAUKESHA WI
53188-5031
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-2400
  • Fax: 262-928-7621
Mailing address:
  • Phone: 262-928-2400
  • Fax: 262-928-7621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number42991-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: