Provider Demographics
NPI:1346353331
Name:FISHER, STEPHEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
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 1:1675 LEAHY ST
Mailing Address - Street 2:SUITE 326 B
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5500
Mailing Address - Country:US
Mailing Address - Phone:231-728-5055
Mailing Address - Fax:231-728-5058
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:SUITE 326 B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-728-5055
Practice Address - Fax:231-728-5058
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010380662086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2099540Medicaid
MI0611320OtherBCBS PIN
MI0611320OtherBCBS PIN
MIA75290Medicare UPIN