Provider Demographics
NPI:1174631188
Name:FISTER, JAMES S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:FISTER
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 1:2350 ROYAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4719
Mailing Address - Country:US
Mailing Address - Phone:847-931-5300
Mailing Address - Fax:847-931-9072
Practice Address - Street 1:2350 ROYAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4719
Practice Address - Country:US
Practice Address - Phone:847-931-5300
Practice Address - Fax:847-931-9072
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059573207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE6001OtherRR MEDICARE GRP-KANE CTY
CG2631OtherRR MEDICARE GRP-MCHENRY C
207906OtherMEDICARE GRP-MCH
IL036059573Medicaid
200015630OtherRR MEDICARE
208821OtherMEDICARE GRP KANE
IL0354460001Medicare NSC
200015630OtherRR MEDICARE
208821OtherMEDICARE GRP KANE
IL0354460005Medicare NSC
CE6001OtherRR MEDICARE GRP-KANE CTY
IL0354460004Medicare NSC
ILK05861Medicare ID - Type UnspecifiedKANE COUNTY