Provider Demographics
NPI:1407155666
Name:FISCHBACH, KEELY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KEELY
Middle Name:ELIZABETH
Last Name:FISCHBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44004
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4004
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-348-5627
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-8205
Practice Address - Country:US
Practice Address - Phone:352-294-8278
Practice Address - Fax:904-348-5627
Is Sole Proprietor?:No
Enumeration Date:2011-03-26
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301500649207R00000X
OH35.134374207R00000X
FLME117183207R00000X
IN01088492A207R00000X
IL036.162510207R00000X
VA0101273000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011168400Medicaid
FLP01366911OtherRAILROAD MEDICARE
FLHV127YMedicare PIN
FLP01366911OtherRAILROAD MEDICARE