Provider Demographics
NPI:1033116710
Name:FISCHER, WADE L (MD)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:L
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W OAK ST STE 360
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4910
Mailing Address - Country:US
Mailing Address - Phone:407-846-0090
Mailing Address - Fax:215-255-3577
Practice Address - Street 1:720 W OAK ST STE 360
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4910
Practice Address - Country:US
Practice Address - Phone:215-762-3900
Practice Address - Fax:215-762-3846
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9027208G00000X
KS040429715208G00000X
WI60813208G00000X
PAMD454858208G00000X
FLME133610208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040881702Medicaid
KS100422820AMedicaid
TX1033116710OtherBLUE CROSS BLUE SHIELD
TX040881703Medicaid
TX040881704Medicaid
TXTXB101180Medicare PIN
KSG16428Medicare UPIN
KS100422820AMedicaid
KS100422820AMedicaid