Provider Demographics
NPI:1548243538
Name:FISHER, MICHIELLE N (MD)
Entity Type:Individual
Prefix:
First Name:MICHIELLE
Middle Name:N
Last Name:FISHER
Suffix:
Gender:F
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:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1936 AMELIA CT
Practice Address - Street 2:SENIOR HOUSE CALLS- SUPPORT BLDG C
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7706
Practice Address - Country:US
Practice Address - Phone:214-590-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161172504Medicaid
TX161172514Medicaid
TX161172501Medicaid
TX161172510Medicaid
TX161172507Medicaid
TX161172517Medicaid
TX161172512Medicaid
TX161172515Medicaid
TX161172516Medicaid
TX161172506Medicaid
TX8S4398OtherBLUE CROSS BLUE SHIELD
TX161172503Medicaid
TX161172508Medicaid
TX161172513Medicaid
TX161172504Medicaid
TXH88840Medicare UPIN