Provider Demographics
NPI:1346251303
Name:FISCHER, JEFFREY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:FISCHER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9226 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3503
Mailing Address - Country:US
Mailing Address - Phone:414-449-3338
Mailing Address - Fax:414-449-1987
Practice Address - Street 1:9226 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-3503
Practice Address - Country:US
Practice Address - Phone:414-449-3338
Practice Address - Fax:414-449-1987
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI692213E00000X
WI692-025213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43218100Medicaid
WI82287Medicare ID - Type UnspecifiedMILWAUKEE
WI85382Medicare ID - Type UnspecifiedOUTSIDE MILWAUKEE
WI43218100Medicaid
WI0557030003Medicare NSC