Provider Demographics
NPI:1407073497
Name:ALBERT L. FISHER M.D.
Entity Type:Organization
Organization Name:ALBERT L. FISHER M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-236-3290
Mailing Address - Street 1:400 CEAPE AVE
Mailing Address - Street 2:#14
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-5227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 CEAPE AVE
Practice Address - Street 2:#14
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-5227
Practice Address - Country:US
Practice Address - Phone:920-236-3290
Practice Address - Fax:920-236-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30483100Medicaid
WI=========015OtherBLUE CROSS BLUE SHIELD WI
WI=========015OtherBLUE CROSS BLUE SHIELD WI
B52804Medicare UPIN