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NPI Code Detail

MEDICARE: MARK THOMAS FISHER MD

MEDICARE: MARK THOMAS FISHER MD
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
12081P0010XPediatric Rehabilitation Medicine Physician2017014405MO

General Provider Information

NPI Number : 1598007254
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK THOMAS FISHER MD
Provider Business Mailing Address
First Line : 2401 GILLHAM RD STE 140
Second Line :
City : KANSAS CITY
State : MO
Zip : 64108-4619
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2401 GILLHAM RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64108-4619
Country : US
Telephone Number : 816-234-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2013
Last Update Date : 05/21/2019

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