MEDICARE: DR. BRUCE J FISCH 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
1	207RN0300X	Nephrology Physician	31254	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	C462628	OTHER	CO	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639151913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE J FISCH MD

Provider Business Mailing Address
First Line	:	130 RAMPART WAY
Second Line	:	300-B
City	:	DENVER
State	:	CO
Zip	:	80230-6440
Country	:	US
Telephone Number	:	303-327-4700
Fax Number	:	303-327-4711

Provider Business Practice Location Address
First Line	:	9695 S YOSEMITE ST
Second Line	:	SUITE 285
City	:	LONE TREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:	303-799-8760
Fax Number	:	303-799-8767

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	04/17/2015

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