Provider Demographics
NPI:1235202094
Name:FISCH, AMY HEATHER (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:HEATHER
Last Name:FISCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:HEATHER
Other - Last Name:KAUFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9500 S DADELAND BLVD
Mailing Address - Street 2:200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2824
Mailing Address - Country:US
Mailing Address - Phone:305-468-4185
Mailing Address - Fax:305-675-3378
Practice Address - Street 1:7875 SW 104TH ST
Practice Address - Street 2:201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2677
Practice Address - Country:US
Practice Address - Phone:305-270-7572
Practice Address - Fax:305-270-1974
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB07903200174400000X
FLOS14201207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS14201OtherMEDICAL LICENSE
NJI43849Medicare UPIN
I43849Medicare UPIN