MEDICARE: MR. MICHAEL LAWRENCE FISHER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	9800047	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080164417	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1125F	OTHER	NC	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104822196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL LAWRENCE FISHER M.D.

Provider Business Mailing Address
First Line	:	4355 HICKORY BLVD
Second Line	:
City	:	GRANITE FALLS
State	:	NC
Zip	:	28645-1992
Country	:	US
Telephone Number	:	828-757-5060
Fax Number	:	828-757-5064

Provider Business Practice Location Address
First Line	:	4355 HICKORY BLVD
Second Line	:
City	:	GRANITE FALLS
State	:	NC
Zip	:	28645-1992
Country	:	US
Telephone Number	:	828-757-5060
Fax Number	:	828-757-5064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	10/14/2011

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