Provider Demographics
NPI:1003906819
Name:FISCHMAN & BORGMEIER MD PA
Entity Type:Organization
Organization Name:FISCHMAN & BORGMEIER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FISCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-569-6114
Mailing Address - Street 1:1600 36TH STREET
Mailing Address - Street 2:STE C
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:38960
Mailing Address - Country:US
Mailing Address - Phone:772-569-6112
Mailing Address - Fax:772-569-5058
Practice Address - Street 1:1600 36TH STREET
Practice Address - Street 2:STE C
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:38960
Practice Address - Country:US
Practice Address - Phone:772-569-6112
Practice Address - Fax:772-569-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25700207KA0200X, 207RP1001X
FLME0089867207R00000X
FLME62133207RE0101X
FLME44223207RR0500X
FLPA91103803363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
39117Medicare PIN