MEDICARE: DR. ROBERT N. FISH M.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	207L00000X	Anesthesiology Physician	55659-020	WI
2	207L00000X	Anesthesiology Physician	2010-00086	NC

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	:	1942292610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT N. FISH M.D.

Provider Business Mailing Address
First Line	:	975 PORT WASHINGTON RD
Second Line	:
City	:	GRAFTON
State	:	WI
Zip	:	53024-9201
Country	:	US
Telephone Number	:	262-329-1000
Fax Number	:	262-329-1001

Provider Business Practice Location Address
First Line	:	975 PORT WASHINGTON RD
Second Line	:
City	:	GRAFTON
State	:	WI
Zip	:	53024-9201
Country	:	US
Telephone Number	:	262-329-1000
Fax Number	:	262-329-1001

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	11/18/2021

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