Provider Demographics
NPI:1023040573
Name:THOMAS L. FISHER, M.D., S.C.
Entity Type:Organization
Organization Name:THOMAS L. FISHER, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHER,
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:312-922-3011
Mailing Address - Street 1:47 W POLK ST LBBY G1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2087
Mailing Address - Country:US
Mailing Address - Phone:312-922-3011
Mailing Address - Fax:312-922-5875
Practice Address - Street 1:47 W POLK ST LBBY G1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2087
Practice Address - Country:US
Practice Address - Phone:312-922-3011
Practice Address - Fax:312-922-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty