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General NPI Number Information
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NPI Number | 1932736816
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Entity Type | Individual
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Provider Name | TAYLOR EVAN FISHER PA
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Gender | Male
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 1140 N STATE ST
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City | SAINT IGNACE
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State | MI
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Zip | 49781-1048
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Country | US
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Telephone | 906-643-8585
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Fax | 906-643-0461
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Provider Business Mailing Address
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Address Line | 3033 N SHERIDAN RD APT 301
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City | CHICAGO
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State | IL
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Zip | 60657-5578
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Country | US
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Telephone | 312-402-8815
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601010463
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License Number State | MI
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