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General NPI Number Information
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NPI Number | 1427073543
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Entity Type | Individual
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Provider Name | THOMAS LEE FISHER SR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 47 W POLK ST LBBY G1
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City | CHICAGO
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State | IL
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Zip | 60605-2087
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Country | US
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Telephone | 312-922-3011
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Fax | 312-922-5875
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Provider Business Mailing Address
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Address Line | 47 W POLK ST LBBY G1
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City | CHICAGO
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State | IL
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Zip | 60605-2087
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Country | US
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Telephone | 312-922-3011
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Fax | 312-922-5875
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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 | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 036-043966
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 036-043966
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036-043966
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License Number State | IL
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