Provider Demographics
NPI:1114467396
Name:FISHER, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27137 W FENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TOWER LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7800
Mailing Address - Country:US
Mailing Address - Phone:847-220-1066
Mailing Address - Fax:
Practice Address - Street 1:200 W HIGGINS RD
Practice Address - Street 2:SUITE 332
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3718
Practice Address - Country:US
Practice Address - Phone:630-237-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001281253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care