MEDICARE: THOMAS L FISHER JR. MD., M.P.H

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	207P00000X	Emergency Medicine Physician	01058727	IN

General Provider Information

NPI Number	:	1275528499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS L FISHER JR. MD., M.P.H

Provider Business Mailing Address
First Line	:	4736 S SAINT LAWRENCE AVE # 3S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-1508
Country	:	US
Telephone Number	:	773-548-7127
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-9501
Fax Number	:

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/08/2007

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