Provider Demographics
NPI:1487689212
Name:FISCHER, KEITH J (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:J
Last Name:FISCHER
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 1:3019 BOHNET BLVD N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1726
Mailing Address - Country:US
Mailing Address - Phone:701-232-3241
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-232-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11866Medicaid
ND6606914OtherMEDICA #
NDHP29759OtherHEALTHPARTNERS #
ND0117866OtherMEDICA #
ND236723800Medicaid
ND38625OtherLHS #
ND926S4FIOtherMNBS #
ND939336OtherAMERICA'S PPO/ARAZ #
ND25057OtherNDBS #
NDDA9011021844OtherPREFERRED ONE #
ND25057Medicare ID - Type UnspecifiedND MEDICARE #
ND11866Medicaid
ND6606914OtherMEDICA #