MEDICARE: WILLIAM D FISHCO DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC4277	OTHER	AZ	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1770740953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM D FISHCO DPM

Provider Business Mailing Address
First Line	:	6036 N 19TH AVE
Second Line	:	SUITE 204
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2106
Country	:	US
Telephone Number	:	602-933-2700
Fax Number	:	602-993-2705

Provider Business Practice Location Address
First Line	:	41818 N VENTURE DR
Second Line	:	SUITE 110
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3188
Country	:	US
Telephone Number	:	602-993-2700
Fax Number	:	602-993-2705

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM D FISHCO
Credential	:	DPM
Telephone Number	:	602-993-2700

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	03/10/2009

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Directions to “WILLIAM D FISHCO DPM ” Practice Location

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