Provider Demographics
NPI:1518195106
Name:FISH, MICHELLE AN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:AN
Last Name:FISH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:AN
Other - Last Name:FISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:4100 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5941
Practice Address - Country:US
Practice Address - Phone:504-703-2750
Practice Address - Fax:504-703-2751
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13722207Q00000X
TXP3884207Q00000X
NVDO2500207Q00000X
CA17945207Q00000X
LADO.000311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine