Provider Demographics
NPI:1073015269
Name:FISHKIN, MICHAEL MARTIN (CPED)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MARTIN
Last Name:FISHKIN
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 ABBEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-2470
Mailing Address - Country:US
Mailing Address - Phone:847-915-0547
Mailing Address - Fax:
Practice Address - Street 1:508 ABBEYWOOD DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2470
Practice Address - Country:US
Practice Address - Phone:847-915-0547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist