MEDICARE: DR. ELLEN FISCHER DDS

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	1223G0001X	General Practice Dentistry	5984-015	WI
2	122300000X	Dentist	019.028607	IL

General Provider Information

NPI Number	:	1609967694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN FISCHER DDS

Provider Business Mailing Address
First Line	:	318 SATTLEY ST
Second Line	:	PO BOX 55
City	:	ROCHESTER
State	:	IL
Zip	:	62563-9241
Country	:	US
Telephone Number	:	217-498-3622
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 SATTLEY ST
Second Line	:
City	:	ROCHESTER
State	:	IL
Zip	:	62563-9241
Country	:	US
Telephone Number	:	217-498-3622
Fax Number	:

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	09/25/2014

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