MEDICARE: DR. THOMAS FISHER PH.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	103G00000X	Clinical Neuropsychologist	820	WI
2	103TH0100X	Health Service Psychologist	820	WI
3	103TR0400X	Rehabilitation Psychologist	820	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40129	OTHER		NATIONAL REGISTER OF HEAL

General Provider Information

NPI Number	:	1316008303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS FISHER PH.D.

Provider Business Mailing Address
First Line	:	2419 S. LENOX STREET
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207
Country	:	US
Telephone Number	:	414-704-1431
Fax Number	:

Provider Business Practice Location Address
First Line	:	2419 S. LENOX STREET
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207
Country	:	US
Telephone Number	:	414-704-1431
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	09/11/2025

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