Provider Demographics
NPI:1568414845
Name:FISH, CHRISTOPHER MILES K (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MILES K
Last Name:FISH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1535 GULL RD
Mailing Address - Street 2:MSB 015
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1650
Mailing Address - Country:US
Mailing Address - Phone:269-226-6933
Mailing Address - Fax:269-226-6949
Practice Address - Street 1:1535 GULL RD
Practice Address - Street 2:MSB 015
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1650
Practice Address - Country:US
Practice Address - Phone:269-226-6933
Practice Address - Fax:269-226-6949
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010858207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2927272-11OtherMEDICAID THREE RIVERS
MI114155871Medicaid
MI1417961137OtherBCBSM - BRONSON VICKSBURG OUTPATIENT CENTER
MI1568414845Medicaid
MIWF061878OtherBLUE CROSS BLUE SHIELD
MI1568414845Medicaid
MIWF061878OtherBLUE CROSS BLUE SHIELD
MIE87923Medicare UPIN
MIC97618235 - BV OPCMedicare PIN