Provider Demographics
NPI:1528038718
Name:FISHER, FRED HARRY (CSA)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:HARRY
Last Name:FISHER
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5944
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-5944
Mailing Address - Country:US
Mailing Address - Phone:630-393-3731
Mailing Address - Fax:630-393-3732
Practice Address - Street 1:29W505 CERNY CIR
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-2516
Practice Address - Country:US
Practice Address - Phone:630-922-9881
Practice Address - Fax:630-393-3732
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000008246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL238.000008OtherLICENSE