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General NPI Number Information
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NPI Number | 1720287071
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Entity Type | Organization
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Legal Business Name | RENAISSANCE FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 12/28/2018
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Provider Practice Location Address
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Address Line | 2580 CHARLESTOWN RD SUITE 2
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City | NEW ALBANY
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State | IN
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Zip | 47150
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Country | US
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Telephone | 812-948-9500
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Fax | 812-948-9600
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Provider Business Mailing Address
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Address Line | 2580 CHARLESTOWN RD SUITE 2
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City | NEW ALBANY
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State | IN
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Zip | 47150
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Country | US
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Telephone | 812-948-9500
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Fax | 812-948-9600
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | DR. ANNA M. FISHER
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Credential | MD
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Telephone | 812-948-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01036882A
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License Number State | IN
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