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General NPI Number Information
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NPI Number | 1205609781
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Entity Type | Individual
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Provider Name | CHRISTIAN MATTHEW FISHWICK
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Gender | Male
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 1114 CHARLEVOIX AVE
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City | PETOSKEY
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State | MI
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Zip | 49770-9701
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Country | US
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Telephone | 231-489-8151
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Fax |
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Provider Business Mailing Address
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Address Line | 2373 RIDGE RD
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City | WHITE LAKE
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State | MI
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Zip | 48383-1746
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Country | US
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Telephone | 248-894-1694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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