Provider Demographics
NPI:1558645200
Name:FLEISCHMAN, MICHAEL (CBPM)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:FLEISCHMAN
Suffix:
Gender:M
Credentials:CBPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 KELP AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-9018
Mailing Address - Country:US
Mailing Address - Phone:641-472-7741
Mailing Address - Fax:
Practice Address - Street 1:1938 KELP AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-9018
Practice Address - Country:US
Practice Address - Phone:641-472-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03213261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain