Provider Demographics
NPI:1104822196
Name:FISHER, MICHAEL LAWRENCE (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:FISHER
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 1:4355 HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28645-1992
Mailing Address - Country:US
Mailing Address - Phone:828-757-5060
Mailing Address - Fax:828-757-5064
Practice Address - Street 1:4355 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28645-1992
Practice Address - Country:US
Practice Address - Phone:828-757-5060
Practice Address - Fax:828-757-5064
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1125FOtherBCBS
080164417OtherRAILROAD MEDICARE
NC891125FMedicaid
080164417Medicare PIN
NC1125FOtherBCBS
G45353Medicare UPIN
80164417Medicare PIN